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Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative
Rahul Saxena1, Tripti Agrawal2, Rahul Saxen2
1Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India. drrahulsaxena@gmail.com.
Insights
Preoperative nutritional status in pediatric surgical patients, assessed by anthropometrics, did not correlate with postoperative complications. Further research is needed to confirm these findings in pediatric surgery outcomes.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Clinical Outcomes Research
Background:
- Malnutrition is prevalent in pediatric surgical populations.
- Assessing preoperative nutritional status is crucial for predicting surgical outcomes.
- Anthropometric measures are commonly used to evaluate nutritional status.
Purpose of the Study:
- To investigate the association between preoperative nutritional status and postoperative complications in pediatric surgical patients.
- To evaluate the predictive value of anthropometric measures for surgical outcomes in children.
- To identify risk factors for complications following pediatric elective surgery.
Main Methods:
- Prospective observational cohort study of 650 pediatric patients (6 months to 18 years) undergoing elective surgery.
- Nutritional status assessed using Z-scores for weight, length, and BMI.
- Postoperative complications monitored for one month using the Clavien-Dindo classification; hospital stay and readmission were secondary outcomes.
Main Results:
- A significant proportion of patients (over 40%) exhibited malnutrition (wasting, stunting, or underweight).
- No significant difference in postoperative complication rates was observed between malnourished and well-nourished pediatric surgical patients.
- Prolonged surgery duration (>2 hours) was associated with increased complications, longer hospital stays, and higher readmission rates.
Conclusions:
- Preoperative nutritional status, based on anthropometric parameters, does not appear to be a significant predictor of postoperative complications in pediatric surgical patients.
- Further randomized controlled trials are warranted to establish a definitive link between preoperative malnutrition and clinical outcomes in this population.
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.
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