Stey Anne, Ricks-Oddie Joni, Innis Sheila, Rangel Shawn J, Moss R Lawrence, Hall Bruce L, Dibbins Albert, Skarsgard Erik D
University of California San Francisco, San Francisco, California, USA.
Institute for Digital Research and Education, University of California Los Angeles, Los Angeles, California, USA.
BMJ Paediatr Open. 2018 Oct 12;2(1):e000303. doi: 10.1136/bmjpo-2018-000303. eCollection 2018.
WHO uses anthropometric classification scheme of childhood acute and chronic malnutrition based on low body mass index (BMI) ('wasting') and height for age ('stunting'), respectively. The goal of this study was to describe a novel two-axis nutritional classification scheme to (1) characterise nutritional profiles in children undergoing abdominal surgery and (2) characterise relationships between preoperative nutritional status and postoperative morbidity.
This was a retrospective observational cohort study.
The setting was 50 hospitals caring for children in North America that participated in the American College of Surgeons National Surgical Quality Improvement Program Paediatric from 2011 to 2013.
Children >28 days who underwent major abdominal operations were identified.
INTERVENTIONS/MAIN PREDICTOR: The cohort of children was divided into five nutritional profile groups based on both BMI and height for age Z-scores: (1) underweight/short, (2) underweight/tall, (3) overweight/short, (4) overweight/tall and (5) non-outliers (controls).
Multiple variable logistic regressions were used to quantify the association between 30-day morbidity and nutritional profile groups while adjusting for procedure case mix, age and American Society of Anaesthesiologists class.
A total of 39 520 cases distributed as follows: underweight/short (656, 2.2%); underweight/tall (252, 0.8%); overweight/short (733, 2.4%) and overweight/tall (1534, 5.1%). Regression analyses revealed increased adjusted odds of composite morbidity (35%) and reintervention events (75%) in the underweight/short group, while overweight/short patients had increased adjusted odds of composite morbidity and healthcare-associated infections (43%), and reintervention events (79%) compared with controls.
Stratification of preoperative nutritional status using a scheme incorporating both BMI and height for age is feasible. Further research is needed to validate this nutritional risk classification scheme for other surgical procedures in children.
世界卫生组织分别采用基于低体重指数（BMI）（“消瘦”）和年龄别身高（“发育迟缓”）的儿童急性和慢性营养不良人体测量分类方案。本研究的目的是描述一种新的双轴营养分类方案，以（1）描述接受腹部手术儿童的营养状况，以及（2）描述术前营养状况与术后发病率之间的关系。
这是一项回顾性观察队列研究。
研究背景为2011年至2013年期间参与美国外科医师学会国家外科质量改进计划儿科项目的北美50家儿童护理医院。
确定了年龄大于28天且接受重大腹部手术的儿童。
干预措施/主要预测因素：根据BMI和年龄别身高Z评分将儿童队列分为五个营养状况组：（1）体重不足/矮小，（2）体重不足/高大，（3）超重/矮小，（4）超重/高大，以及（5）非异常值（对照组）。
采用多变量逻辑回归分析，在调整手术病例组合、年龄和美国麻醉医师协会分级的同时，量化30天发病率与营养状况组之间的关联。
共39520例病例，分布如下：体重不足/矮小（656例，2.2%）；体重不足/高大（252例，0.8%）；超重/矮小（733例，2.4%）；超重/高大（1534例，5.1%）。回归分析显示，体重不足/矮小组的复合发病率（35%）和再次干预事件（75%）的调整后比值增加，而超重/矮小患者与对照组相比，复合发病率和医疗相关感染（43%）以及再次干预事件（79%）的调整后比值增加。
使用结合BMI和年龄别身高的方案对术前营养状况进行分层是可行的。需要进一步研究以验证该营养风险分类方案对儿童其他外科手术的有效性。
