Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC.
Department of Pediatrics, Division of Gastroenterology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill.
J Pediatr Surg. 2021 Mar;56(3):439-445. doi: 10.1016/j.jpedsurg.2020.10.001. Epub 2020 Oct 18.
There is a limited understanding of the impact of pediatric malnutrition indicators on post-operative outcomes.
All pediatric surgical patients captured in the ACS NSQIP-Pediatric database from 2016 to 2018 were included. Multivariable logistic regression was used to estimate odds of 30-day post-operative infection by malnutrition definition (stunted, wasted, requiring nutritional support, pre-operative hypoalbuminemia).
Among pediatric surgery patients (n = 282,056), 19% of patients met one definition of malnutrition, 6% met two, 1% met 3, and <0.1% met all 4. After adjustment, requiring nutritional support (OR 1.47, 95% CI 1.36-1.60), stunting (OR 1.17, 95% CI 1.10-1.25), and hypoalbuminemia (OR 1.17 95% CI 1.04-1.32) were associated with increased odds of post-operative infection while wasting was not. Requiring nutritional support was associated in an increase of 10.17 days (95% CI 9.89-10.44) in time from admission to surgery.
The metric used to define malnutrition changed the association with post-operative outcomes. Nutritional supplementation, stunting, and hypoalbuminemia were associated with poorer postoperative outcomes. These findings have implications for pre-operative patient level counseling, accurate risk stratification, surgical planning, and patient optimization in pediatric surgery.
III.
目前对于小儿营养不良指标对术后结果的影响知之甚少。
本研究纳入了 2016 年至 2018 年 ACS NSQIP-Pediatric 数据库中所有小儿外科患者。采用多变量逻辑回归估计营养不良定义（发育迟缓、消瘦、需要营养支持、术前低白蛋白血症）与 30 天术后感染的比值比。
在小儿外科患者（n=282056）中，19%的患者符合营养不良的一种定义，6%符合两种，1%符合三种，<0.1%符合四种。调整后，需要营养支持（OR 1.47，95%CI 1.36-1.60）、发育迟缓（OR 1.17，95%CI 1.10-1.25）和低白蛋白血症（OR 1.17 95%CI 1.04-1.32）与术后感染的几率增加相关，而消瘦则不然。需要营养支持与从入院到手术的时间增加了 10.17 天（95%CI 9.89-10.44）相关。
用于定义营养不良的指标改变了其与术后结果的相关性。营养补充、发育迟缓及低白蛋白血症与术后不良结局相关。这些发现对小儿外科术前患者个体化咨询、准确的风险分层、手术规划和患者优化具有重要意义。
III。
