Measuring malnutrition and its impact on pediatric surgery outcomes: a NSQIP-P analysis
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In brief
In brief
Large-scale NSQIP-P database analysis (282,056 patients) reveals that preoperative nutritional support dependence, growth stunting, and hypoalbuminemia significantly increase postoperative infection risk in pediatric surgical patients, while wasting shows no association. Findings emphasize the importance of standardized malnutrition screening and preoperative optimization to improve surgical outcomes and enable accurate risk counseling.
Written by the GCMD Library team from the article.
Abstract
Background
There is a limited understanding of the impact of pediatric malnutrition indicators on post-operative outcomes.
Materials and methods
All pediatric surgical patients captured in the ACS NSQIP-Pediatric database from 2016 to 2018 were included. Multivariable logistic regression was used to estimate odds of 30-day post-operative infection by malnutrition definition (stunted, wasted, requiring nutritional support, pre-operative hypoalbuminemia).
Results
Among pediatric surgery patients (n = 282,056), 19% of patients met one definition of malnutrition, 6% met two, 1% met 3, and <0.1% met all 4. After adjustment, requiring nutritional support (OR 1.47, 95% CI 1.36–1.60), stunting (OR 1.17, 95% CI 1.10–1.25), and hypoalbuminemia (OR 1.17 95% CI 1.04–1.32) were associated with increased odds of post-operative infection while wasting was not. Requiring nutritional support was associated in an increase of 10.17 days (95% CI 9.89–10.44) in time from admission to surgery.
Conclusions
The metric used to define malnutrition changed the association with post-operative outcomes. Nutritional supplementation, stunting, and hypoalbuminemia were associated with poorer postoperative outcomes. These findings have implications for pre-operative patient level counseling, accurate risk stratification, surgical planning, and patient optimization in pediatric surgery.
Level of Evidence
III.