Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa.
J Pediatr Surg. 2021 Feb;56(2):368-373. doi: 10.1016/j.jpedsurg.2020.09.020. Epub 2020 Oct 1.
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.
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.
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.
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.
Level II treatment study.
在全球范围内，营养不良导致近 50%的儿童死亡，但营养状况与术后并发症之间的关联仍存在争议。本研究旨在描述津巴布韦儿科手术患者的术前营养状况，并评估营养状况是否是术后死亡、手术部位感染、再次手术、再次入院和住院时间延长等不良预后的危险因素。
本前瞻性观察队列研究纳入了在津巴布韦一家三级儿科医院接受手术的 136 名儿童。使用 BMI、身高、体重和中上臂围的 Z 分数对营养状况进行标准化。术后 30 天的主要结局包括死亡、手术部位感染、再次手术和再次入院。次要结局为住院时间。采用单变量和多变量逻辑回归进行分析。
在 136 名患者中，31%存在营养不良。术后不良结局发生率为 20%；死亡率为 6%，手术部位感染率为 17%，再次手术率为 3.5%，再次入院率为 2.5%。营养状况、较高的 ASA 分级、大型手术和较低的术前血红蛋白水平与不良结局相关。单变量逻辑回归发现，营养不良的儿童术后并发症风险增加 7 倍（OR 7.3 [2.3-22.8]，p=0.001），在调整 ASA、大型手术和术前血红蛋白后，调整后的风险增加 4 至 6 倍。
三分之一的儿科手术患者存在营养不良，而营养不良的儿童发生不良结局的风险明显更高。营养不良与术后并发症增加之间存在正相关，未来的目标将包括评估术前营养治疗是否对营养不良的儿童特别有益。
II 级治疗研究。
