Measuring malnutrition and its impact on pediatric surgery outcomes: A NSQIP-P analysis.

Background: There is a limited understanding of the impact of pediatric malnutrition indicators on post-operative outcomes.

Materials And Methods: 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).

Results: 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.

Conclusions: 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.

Level Of Evidence: III.