Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients
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In brief
In brief
This prospective study of 627 pediatric surgical patients examined whether preoperative malnutrition (assessed by anthropometric Z-scores) predicts postoperative complications. Despite high malnutrition rates (47-84% depending on measure and age group), nutritional status did not significantly correlate with complications, though surgery duration >2 hours did increase complication risk in both age groups.
- Malnutrition prevalence was high: 47.71% wasting in younger children (6mo-5y) and 83.75% stunting in older children (5-18y).
- Preoperative malnutrition assessed by anthropometry alone did not predict increased postoperative complications in this cohort.
- Surgery duration >2 hours was strongly associated with complications (67.2% in younger, 82.6% in older children; p<0.0001).
- Patients with complications had significantly longer hospital stays and higher 30-day readmission rates in both age groups.
- Anthropometric measures may be insufficient; multimodal nutritional assessment needed to predict surgical risk in pediatric patients.
Written by the GCMD Library team from the article.
Abstract
Aim
To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients.
Methodology
This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien–Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes.
Results
There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A—67.2%, Group B—82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B).
Conclusion
In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.