Prevalence and outcome of malnutrition among pediatric surgical patients in anesthesia and Critical care department: A prospective observational cohort study at Kigali Teaching University

Abstract

Background: Malnutrition is common in pediatric surgical patients in low- and middle-income countries, and children are particularly at risk for poor outcomes after surgery. We aimed to determine the prevalence of malnutrition and its association with postoperative outcomes among paediatric surgical patients. Methods: Prospective observational cohort study. We enrolled surgical patients between 1 month and 15 years. We measured the association of acute and chronic malnutrition with postoperative LOS using log-gamma regression to account for the skewed LOS distribution. Adjustment was made for sex, age, elective vs emergency surgery, household income, and ASA classification. Results: Among 593 children, the acute malnutrition (wasting) was present in 124 (21.1%); 160 (26.98%) had chronic malnutrition with 13.66% severely stunted. Mean LOS after surgery was 4.5 (SD 5.5) days for children with mild/no acute malnutrition, 9.4 (SD 10.02) days for children with moderate and 10.8 (SD 14.1) days with severe acute malnutrition. For chronic malnutrition, the mean LOS after surgery was 4.8 (SD 6.1) days for children with mild/no chronic malnutrition, 7.1 (SD 10.06) days for children with moderate and 9.06 (SD 10.10) days with severe chronic malnutrition. Prior to adjustment, severe, but not moderate, malnutrition was associated with increased LOS (ratio of means (RoM) vs. no/mild malnutrition: 1.78; 95%CI 1.42-2.25; p 0.0001 for severe, and 1.23; 95%CI 0.97-1.55; p=0.086 for moderate). Following covariate adjustment these associations persisted (RoM 1.44; 95%CI 1.17-1.78; p=0.0006 for severe vs no/mild; 1.04; 95%CI 0.84-1.29; p=0.695 for moderate). Conclusion: Severe malnutrition is prevalent and independently associated with increased LOS after surgery, even after accounting for individual and family-level confounders. Although some of this malnutrition may related to the surgical condition, severe malnutrition may represent a modifiable social risk factor that could be targeted to improve postoperative outcomes and resource use.