Measuring malnutrition and its impact on pediatric surgery outcomes: a NSQIP-P analysis
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Topic overview
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.
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