Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of preoperative nutritional status on surgical outcomes in patients with pediatric gastrointestinal surgery

  • El Koofy, Nehal (Cairo University, Pediatric Department, Cairo University Specialized Pediatric Hospital) ;
  • Eldin, Hadeer Mohamed Nasr (Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital) ;
  • Mohamed, Wesam (Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital) ;
  • Gad, Mostafa (Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital) ;
  • Tarek, Sara (Cairo University, Pediatric Department, Cairo University Specialized Pediatric Hospital) ;
  • El Tagy, Gamal (Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital)
  • Received : 2020.03.30
  • Accepted : 2020.11.07
  • Published : 2021.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Malnutrition has a high incidence among pediatric surgical patients and contributes to increased risks of postoperative complications and extended hospital stays. Purpose: The present study aimed to determine the influence of preoperative nutritional status on the postoperative outcomes of pediatric patients who underwent elective gastrointestinal (GI) surgery. Methods: This prospective observational study was conducted at Cairo University Specialized Pediatric Hospital. According to the designated inclusion criteria, 75 surgical cases of both sexes were included. A structured questionnaire was developed and administered. This questionnaire included 3 main sections: demographic data and nutritional status parameters at admission and discharge. Pre- and postoperative nutritional statuses were compared. Results: According to both the subjective global nutritional assessment and STRONGKIDS score Questioner, more than 60% of patients in the upper GI patient group were at risk of malnutrition. Wasting status was most common in the upper GI patient group (67%; vs. 39.1% in the lower GI group). Underweight status was more common in the hepatobiliary and upper GI patient groups (nearly 50% for each group) than in the lower GI group (30.4%). On the other hand, stunted patients had a higher incidence of complications and a prolonged hospital stay (P=0.003 and P=0.037, respectively), while underweight lower GI patients experienced a prolonged hospital stay (P=0.02). A higher proportion of patients with preoperative anemia than those without preoperative anemia required a blood transfusion (P=0.003). Conclusion: Nutritional assessment is a crucial component of pediatric surgical patient management. Both underweight and wasting statuses were more common among hepatobiliary and upper GI patients. Postoperative complications and a long hospital stay were more common among stunted patients.

Keywords

References

  1. Falcao MC, Tannuri U. Nutrition for the pediatric surgical patient: approach in the peri-operative period. Rev Hosp Clin Fac Med Sao Paulo 2005;57:299-308. https://doi.org/10.1590/S0041-87812002000600010
  2. Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature. J Gastrointest Surg 2008;12:739-55. https://doi.org/10.1007/s11605-007-0362-1
  3. Cardinale F, Chinellato I, Caimmi S, Peroni DG, Franceschini F, Miraglia Del Giudice M, et al. Perioperative period: immunological modifications. Int J Immunopathol Pharmacol 2011;24(3 Suppl):S3-12.
  4. Allison SP. Malnutrition, disease, and outcome. Nutrition 2000;16:590-3. https://doi.org/10.1016/S0899-9007(00)00368-3
  5. Sungurtekin H, Sungurtekin U, Balci C, Zencir M, Erdem E. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr 2004;23:227-32. https://doi.org/10.1080/07315724.2004.10719365
  6. Cano NJ, Heng AE, Pison C. Multimodal approach to malnutrition in malnourished maintenance hemodialysis patients. J Ren Nutr 2011;21: 23-6. https://doi.org/10.1053/j.jrn.2010.10.016
  7. Bauer K, Bovermann G, Roithmaier A, Gotz M, Proiss A, Versmold HT. Body composition, nutrition, and fluid balance during the first two weeks of life in preterm neonates weighing less than 1500 grams. J Pediatr 1991; 118:615-20. https://doi.org/10.1016/s0022-3476(05)83390-6
  8. Secker D, Jeejeebhoy K. Subjective Global Assessment for children. Am J Clin Nutr 2007;85:1083-9. https://doi.org/10.1093/ajcn/85.4.1083
  9. Huysentruyt K, Alliet P, Muyshont L, Rossignol R, Devreker T, Bontems P, et al. The STRONG kids nutritional screening tool in hospitalized children: a validation study. Nutrition 2013;29:1356-61. https://doi.org/10.1016/j.nut.2013.05.008
  10. Kuczmarski RJ, Kuczmarski MF, Roche AF. 2000 CDC growth charts: background for clinical application. Top Clin Nutr 2002;17:15-26. https://doi.org/10.1097/00008486-200203000-00006
  11. Van den Broeck J, Willie D, Younger N. The World Health Organization child growth standards: expected implications for clinical and epidemiological research. Eur J Pediatr 2009;168:247-51. https://doi.org/10.1007/s00431-008-0796-9
  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  13. Rogers EJ, Gilbertson HR, Heine RG, Henning R. Barriers to adequate nutrition in critically ill children. Nutrition 2003;19:865-8. https://doi.org/10.1016/S0899-9007(03)00170-9
  14. Yang CH, Perumpail BJ, Yoo ER, Ahmed A, Kerner JA Jr. Nutritional needs and support for children with chronic liver disease. Nutrients 2017;9:1127. https://doi.org/10.3390/nu9101127
  15. Fuhrman MP. The Albumin-nutrition connection: separating myth from fact. Nutrition 2002;18:199-200. https://doi.org/10.1016/S0899-9007(01)00729-8
  16. Wessner S, Burjonrappa S. Review of nutritional assessment and clinical outcomes in pediatric surgical patients: does preoperative nutritional assessment impact clinical outcomes? J Pediatr Surg 2014;49:823-30. https://doi.org/10.1016/j.jpedsurg.2014.01.006
  17. Leite HP, Fisberg M, de Carvalho WB, de Camargo Carvalho AC. Serum albumin and clinical outcome in pediatric cardiac surgery. Nutrition 2005;21:553-8. https://doi.org/10.1016/j.nut.2004.08.026
  18. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015;102:1314-24. https://doi.org/10.1002/bjs.9861
  19. Mahmoud AO, Zayed KM, Shawky NA. Stunting among children attending a Pediatrics Outpatient Clinic in Cairo, Egypt. Egyp J Community Med 2017;35:33-42. https://doi.org/10.21608/ejcm.2017.4091
  20. Neumann CG, Harrison GG. Onset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies. Eur J Clin Nutr 1994; 48 Suppl 1:S90-102.
  21. Canada NL, Mullins L, Pearo B, Spoede E. Optimizing perioperative nutrition in pediatric populations. Nutr Clin Pract 2016;31:49-58. https://doi.org/10.1177/0884533615622639
  22. Lambert E, Carey S. Practice guideline recommendations on perioperative fasting: a systematic review. J Parenter Enter Nutr 2016;40:1158-65. https://doi.org/10.1177/0148607114567713
  23. GlobalSurg Collaborative. Determining the worldwide epidemiology of surgical site infections after gastrointestinal resection surgery: protocol for a multicentre, international, prospective cohort study (GlobalSurg 2). BMJ Open 2017;7:e012150. https://doi.org/10.1136/bmjopen-2016-012150
  24. Schiesser M, Muller S, Kirchhoff P, Breitenstein S, Schafer M, Clavien PA. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr 2008;27:565-70. https://doi.org/10.1016/j.clnu.2008.01.010
  25. Toole BJ, Toole LE, Kyle UG, Cabrera AG, Orellana RA, Coss-Bu JA. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis 2014;9:15-25. https://doi.org/10.1111/chd.12064
  26. Leite HP, Fisberg M, Novo NF, Nogueira EB, Ueda IK. Nutritional assessment and surgical risk markers in children submitted to cardiac surgery. Sao Paulo Med J 1995;113:706-14. https://doi.org/10.1590/s1516-31801995000100008
  27. Brugnara C, Oski FA, Nathan DG. Diagnostic approach to the anemic patient. In: Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, editors. Nathan and Oski's hematology and oncology of infancy and childhood. 8th ed. Philadelphia (PA): WB Saunders, 2015:293.