Preoperative nutritional status significantly impacts patient outcomes after pancreaticoduodenectomy.

• Patients with a Geriatric Nutritional Risk Index (GNRI) < 82 had a 14.93% 30-day mortality and 26.87% 90-day mortality, starkly higher than those in better nutritional categories.
• Major complication rates were 29.85%, with 20.9% requiring reoperation in the low GNRI group.

Improve surgical results by identifying and addressing malnutrition early in these high-risk patients.

• The low GNRI group also faced higher ICU stays (adjusted odds ratio 3.98) and increased healthcare costs.