Nutritional status and outcome of surgery: A prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe

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Nutritional status and outcome of surgery : A prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe. / Bergkvist, Emil; Zimunhu, Taurai; Mbanje, Chenesa; Hagander, Lars; Muguti, G. I.

I: Journal of Pediatric Surgery, Vol. 56, Nr. 2, 2021, s. 368-373.

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TY - JOUR

T1 - Nutritional status and outcome of surgery

T2 - A prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe

AU - Bergkvist, Emil

AU - Zimunhu, Taurai

AU - Mbanje, Chenesa

AU - Hagander, Lars

AU - Muguti, G. I.

PY - 2021

Y1 - 2021

N2 - Background: Undernutrition contributes to nearly 50% of all child deaths in the world, yet there is conflicting evidence regarding the association between nutritional status and postoperative complications. The aim was to describe the preoperative nutritional status among pediatric surgery patients in Zimbabwe, and to assess if nutritional status was a risk factor for adverse postoperative outcome of mortality, surgical site infection, reoperation, readmission, and longer length of stay. Methods: This prospective observational cohort study included 136 children undergoing surgery at a tertiary pediatric hospital in Zimbabwe. Nutritional status was standardized using Z-scores for BMI, length, weight, and middle upper arm circumference. Primary outcomes after 30 days included mortality, surgical site infection, reoperation, and readmission. Secondary outcome was length of stay. Univariate and multivariable analyses with logistic regression were performed. Results: Of the 136 patients, 31% were undernourished. Postoperative adverse outcome occurred in 20%; the mortality rate was 6%, the surgical site infection rate was 17%, the reoperation rate was 3.5%, and readmission rate was 2.5%. Nutritional status, higher ASA classification, major surgical procedures, and lower preoperative hemoglobin levels were associated with adverse outcome. Univariate logistic regression identified a seven-fold increased risk of postoperative complications among undernourished children (OR 7.3 [2.3–22.8], p = 0.001), and there was a four- to six-fold increased adjusted risk after adjustment for ASA, major surgery, and preoperative hemoglobin. Conclusion: A third of all pediatric surgery patients were undernourished, and undernourished children had a considerably higher risk of adverse outcome. With a positive correlation identified between undernourishment and increased postoperative complications, future aims would include assessing if preoperative nutritional treatment could be especially beneficial for undernourished children. Levels of Evidence: Level II treatment study.

AB - Background: Undernutrition contributes to nearly 50% of all child deaths in the world, yet there is conflicting evidence regarding the association between nutritional status and postoperative complications. The aim was to describe the preoperative nutritional status among pediatric surgery patients in Zimbabwe, and to assess if nutritional status was a risk factor for adverse postoperative outcome of mortality, surgical site infection, reoperation, readmission, and longer length of stay. Methods: This prospective observational cohort study included 136 children undergoing surgery at a tertiary pediatric hospital in Zimbabwe. Nutritional status was standardized using Z-scores for BMI, length, weight, and middle upper arm circumference. Primary outcomes after 30 days included mortality, surgical site infection, reoperation, and readmission. Secondary outcome was length of stay. Univariate and multivariable analyses with logistic regression were performed. Results: Of the 136 patients, 31% were undernourished. Postoperative adverse outcome occurred in 20%; the mortality rate was 6%, the surgical site infection rate was 17%, the reoperation rate was 3.5%, and readmission rate was 2.5%. Nutritional status, higher ASA classification, major surgical procedures, and lower preoperative hemoglobin levels were associated with adverse outcome. Univariate logistic regression identified a seven-fold increased risk of postoperative complications among undernourished children (OR 7.3 [2.3–22.8], p = 0.001), and there was a four- to six-fold increased adjusted risk after adjustment for ASA, major surgery, and preoperative hemoglobin. Conclusion: A third of all pediatric surgery patients were undernourished, and undernourished children had a considerably higher risk of adverse outcome. With a positive correlation identified between undernourishment and increased postoperative complications, future aims would include assessing if preoperative nutritional treatment could be especially beneficial for undernourished children. Levels of Evidence: Level II treatment study.

KW - Nutritional status

KW - Pediatric surgery

KW - Perioperative mortality

KW - Postoperative complications

KW - Zimbabwe

U2 - 10.1016/j.jpedsurg.2020.09.020

DO - 10.1016/j.jpedsurg.2020.09.020

M3 - Article

C2 - 33131772

AN - SCOPUS:85094813453

VL - 56

SP - 368

EP - 373

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 1531-5037

IS - 2

ER -