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Assessing malnutrition in cerebral palsy patients and its impact on complications following spinal fusion
Haseeb E Goheer1, Phillip T Yang1, Yasmine S Ghattas1
1Department of Orthopaedic Surgery and Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA.
Insights
Malnutrition in cerebral palsy (CP) patients undergoing spinal fusion increases surgical complication risks. Indicators like nutritional support, wasting, and stunting predict extended ICU stays, unplanned intubation, and infections, respectively.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Orthopedic Surgery
Background:
- Cerebral palsy (CP) patients with severe scoliosis often experience malnutrition.
- Limited research exists on pediatric malnutrition indicators impacting post-operative surgical complications.
- This study investigates nutritional status measures for predicting complications in CP patients undergoing spinal fusion for neuromuscular scoliosis.
Purpose of the Study:
- To examine the relationship between nutritional status indicators and post-operative complications.
- To assess the predictive ability of malnutrition measures in pediatric CP patients undergoing spinal fusion.
- To identify specific malnutrition indicators associated with increased surgical risks.
Main Methods:
- Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2016-2022).
- Identified pediatric CP patients undergoing spinal fusion (CPT Code 22804).
- Utilized univariate and multivariate regression to analyze preoperative characteristics and postoperative complications across malnutrition definitions (stunting, wasting, nutritional support).
Main Results:
- 93.3% of 2017 patients met at least one malnutrition definition.
- Requiring nutritional support independently increased the risk of extended ICU stay (OR: 1.35).
- Wasting independently increased the risk of unplanned intubation (OR: 1.77), and stunting increased the risk of deep surgical site infection (OR: 2.50).
Conclusions:
- Malnourished CP patients requiring nutritional support face higher risks of extended postoperative ICU stays.
- Wasting and stunting are linked to increased risks of unplanned intubation and deep surgical site infections, respectively.
- Personalized postoperative management and multidisciplinary risk assessment are crucial for mitigating complications in these patients.
Background:
Cerebral palsy (CP) patients with severe scoliosis are frequently malnourished. However, there is a paucity of literature focusing on the impact of pediatric malnutrition indicators on post-operative surgical complications. This study aims to examine the relationship between measures of nutritional status and their ability to predict post-operative complications in patients with CP undergoing spinal fusion for neuromuscular scoliosis.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program Pediatric was queried retrospectively to identify pediatric CP patients who had undergone spinal fusions for neuromuscular scoliosis between 2016 and 2022 using the Current Procedural Terminology Code 22804. Univariate and multivariate regression were employed to assess differences in preoperative patient characteristics as well as postoperative complications across malnutrition definitions (stunting, wasting, and requiring nutritional support).
Results:
A total of 2017 patients were identified between 2016 and 2022, of which 1124 received nutritional support and 893 did not. Among all patients, 93.3% (n = 1882) met at least one definition of malnutrition, 58.1% (n = 1172) met two or more definitions, and 9.3% (n = 187) met all three definitions of malnutrition. After adjustment, requiring nutritional support independently increased the risk for an extended intensive care unit stay (OR:1.35; 95 CI [1.01-1.83]; p = 0.047). Wasting independently increased the risk for unplanned intubation (OR:1.77; 95 CI [1.02-3.02]; p = 0.038) while stunting increased the risk for deep/organ space surgical site infection (OR:2.50; 95 CI [1.20-6.10]; p = 0.025).
Conclusion:
Patients with malnutrition (defined as nutritional support) are at increased risk for an extended intensive unit care stay in the postoperative period. Personalized postoperative management with multidisciplinary teams, guided by risk assessment, may help mitigate postoperative complications and address the challenges associated with malnutrition.
Level Of Evidence:
III.
