Low HS-Omega-3 index as a predictor of severe postoperative complications in abdominal surgery: a prospective observational study

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BACKGROUND: Omega-3 supplementation may reduce postoperative complications, but variability in formulations and lack of standardized monitoring limit its use. The HS-Omega-3 Index® offers a standardized measure of omega-3 status, but its role in surgical outcomes remains unexamined. This pilot prospective observational study investigated the association between preoperative HS-Omega-3 Index® and postoperative complications in patients undergoing major gastrointestinal or hepatobiliary surgeries, adopting a broad approach to assess its relevance. METHOD: This study included 269 patients undergoing elective gastrointestinal or hepatobiliary surgery between November 2020 and February 2023, excluding those receiving preoperative parenteral nutrition and other predefined criteria. Preoperative HS-Omega-3 Index® levels were measured and correlated with postoperative complications using the Clavien-Dindo (CD) classification. Logistic regression analysis, adjusted for confounders such as age, smoking status, sarcopenia, and visceral obesity, assessed the association between the HS-Omega-3 Index® and severe complications (CD≥3). RESULTS: The HS-Omega-3 Index® was <8% in 97% (261/269) of patients, with 35.7% (96/269) presenting levels <5%. Postoperative complications occurred in 37.9% (102/269) of patients, with severe complications in 21.6% (58/269) and a mortality rate of 2.6% (7/269). Multivariate analysis revealed a significant association between a lower HS-Omega-3 Index® and increased risk of severe complications (Odds Ratio [ OR ], 0.72; P = 0.037). CONCLUSION: A reduced HS-Omega-3 Index® was highly prevalent in patients undergoing major abdominal surgery and was significantly associated with an increased risk of severe postoperative complications. These findings support the potential utility of the HS-Omega-3 Index® as a preoperative biomarker for risk stratification and for targeted prehabilitation strategies. Further studies are needed to confirm its impact on surgical outcomes.

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