Preoperative Nutrition Status Predicts Hospital Length of Stay and Unplanned Reoperation Risk in Pediatric Patients
Alicia D Menchaca1, Francine Breckler2, Charles P Vanderpool3
1Department of Surgery, Indiana University, Indianapolis, IN 46202, USA.
Insights
Pediatric inflammatory bowel disease (IBD) patients with moderate to severe malnutrition undergoing surgery face longer hospital stays and higher reoperation risks. Nutrition status significantly impacts surgical outcomes in children with IBD.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Science
Background:
- Inflammatory bowel disease (IBD) frequently necessitates surgical intervention in children.
- Poor nutritional status is linked to adverse surgical outcomes in adults, but pediatric data is limited.
- This study investigates the impact of preoperative nutrition on pediatric IBD surgical outcomes.
Purpose of the Study:
- To determine the correlation between preoperative nutrition status and perioperative outcomes in pediatric IBD patients undergoing elective surgery.
- To identify specific nutritional parameters and their association with postoperative complications, length of stay, and reoperation rates.
Main Methods:
- Retrospective review of pediatric IBD patients (≤18 years) undergoing elective surgery (2010-2022).
- Patients categorized by malnutrition severity (none/mild vs. moderate/severe) using BMI Z-scores.
- Outcomes analyzed: postoperative complications, hospital length of stay (LOS), and unplanned reoperation. Sarcopenic measures (psoas index) were also assessed.
Main Results:
- Ninety-three patients included; 23 in the moderate/severe malnutrition group.
- No significant difference in postoperative complication rates between groups.
- Moderate/severe malnutrition linked to significantly longer LOS (p=0.01) and increased risk of unplanned reoperation (p=0.03).
- Higher psoas index observed in the none/mild malnutrition group (p=0.01).
Conclusions:
- Moderate to severe malnutrition in pediatric IBD patients undergoing elective surgery increases risk of prolonged hospital LOS and unplanned reoperation.
- Radiographic sarcopenic measures correlate with malnutrition and may predict postoperative outcomes.
- Further research into sarcopenia as a predictive tool for surgical outcomes in pediatric IBD is warranted.
Introduction:
Many pediatric inflammatory bowel disease (IBD) patients require surgical intervention during their lifetime. Poor nutrition status correlates with adverse surgical outcomes in the adult population. A paucity of data exists on the association of preoperative nutrition status and postoperative outcomes in the pediatric population. We sought to determine the correlation between nutrition status and perioperative outcomes following a planned operation.
Methods:
A retrospective review was conducted at a tertiary children's hospital from January 2010-December 2022 for all children ≤18 years old, with a diagnosis of IBD, undergoing elective surgery, with preoperative nutrition data. Patients were grouped into none/mild malnutrition and moderate/severe malnutrition based on BMI Z-scores or two-weight differences, and outcomes compared: postoperative complications, hospital length of stay (LOS), and unplanned reoperation. Sarcopenic measures based on cross-sectional imaging were collected.
Results:
Ninety-three planned surgical admissions were identified; 70 in the none/mild malnutrition group and 23 in the moderate/severe malnutrition group. There were no significant differences in post-operative complication rates (38.1 % moderate/severe vs. 22.4 % none/mild, p = 0.18). The moderate/severe malnutrition group had a longer LOS (8.6 ± 4.8 days vs. 5.7 ± 2.6 days; p = 0.01) and a higher risk of unplanned reoperation (n = 8, 34.8 % vs. n = 5, 7.1 %, p = 0.03). Psoas index was significantly higher between none/mild and moderate/severe malnutrition groups (6.5 ± 1.9 vs 4.6 ± 2.0, p = 0.01).
Conclusions:
Pediatric IBD patients undergoing elective surgery with moderate/severe malnutrition are at increased risk of a longer hospital LOS and unplanned reoperation. Radiographic sarcopenic measures correlate with malnutrition status based on BMI Z-scores and warrant further investigation for predicting post-operative outcomes in this population.
Level Of Evidence:
IV.
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