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Preoperative Malnutrition Increases Risk of In-Hospital Mortality, Major Infection, and Longer Intensive Care Unit
Rachel E Wittenberg1, Kimberlee Gauvreau1,2, Christopher P Duggan1,2
1Harvard Medical School Boston MA USA.
Insights
Preoperative malnutrition in children undergoing ventricular septal defect (VSD) closure significantly increases risks of death, infection, and longer intensive care unit stays. Underweight status posed the highest mortality risk in this global study.
Area of Science:
- Pediatric Cardiology
- Global Health
- Nutritional Science
Background:
- Children with Ventricular Septal Defect (VSD) often have high energy needs and feeding difficulties, potentially leading to growth failure.
- The impact of preoperative malnutrition on surgical outcomes for VSD repair, particularly in resource-limited settings, remains inadequately understood.
Purpose of the Study:
- To investigate the association between preoperative malnutrition and in-hospital mortality, major infection, and intensive care unit (ICU) stay duration following VSD closure.
- To analyze the predictive value of different malnutrition indicators (wasting, underweight, stunting) on adverse surgical outcomes in pediatric VSD patients.
Main Methods:
- Analysis of a global cohort of 10,966 children under 5 years old undergoing VSD closure from 2015-2020.
- Utilized World Health Organization Child Growth Standards to assess four malnutrition measures: severe wasting, moderate wasting, underweight, and stunting.
- Calculated adjusted odds ratios (ORs) for in-hospital death and major infection, and adjusted coefficients for ICU stay duration.
Main Results:
- Over 74% of the cohort had membranous VSDs, with significant prevalence of malnutrition: 37.3% wasting, 45.9% underweight, and 32.1% stunting.
- Severe wasting (OR, 3.38), underweight (OR, 6.46), and stunting (OR, 2.73) were independent predictors of mortality.
- Underweight emerged as the strongest predictor of adverse outcomes; children with all three malnutrition types faced 17.2 times higher mortality odds.
Conclusions:
- Preoperative malnutrition is significantly associated with increased mortality, infection rates, and prolonged ICU stays in children undergoing VSD closure globally.
- Underweight status is a critical indicator for poor surgical outcomes in this pediatric population.
Background:
High energy requirements and poor feeding can lead to growth failure in patients with ventricular septal defect (VSD), but effects of preoperative malnutrition on surgical outcomes are poorly understood, especially in low-resource settings.
Methods And Results:
We analyzed a cohort of children <5 years of age undergoing VSD closure at 60 global centers participating in the International Quality Improvement Collaborative for Congenital Heart Disease, 2015 to 2020. We calculated adjusted odds ratios (ORs) for in-hospital death and major infection and adjusted coefficients for duration of intensive care unit stay for 4 measures of malnutrition: severe wasting (weight-for-height Z score, <-3), moderate wasting (-3
Conclusions:
Malnutrition was associated with mortality, infection, and longer intensive care unit stay in a global cohort of children undergoing VSD closure.
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