Preoperative Nutrition Status Predicts Hospital Length of Stay and Unplanned Reoperation Risk in Pediatric Patients With Inflammatory Bowel Disease.

Introduction: Many pediatric inflammatory bowel disease (IBD) patients require surgical intervention during their lifetime. Poor nutrition status correlates with adverse surgical outcomes in the adult population. A paucity of data exists on the association of preoperative nutrition status and postoperative outcomes in the pediatric population. We sought to determine the correlation between nutrition status and perioperative outcomes following a planned operation.

Methods: A retrospective review was conducted at a tertiary children's hospital from January 2010-December 2022 for all children ≤18 years old, with a diagnosis of IBD, undergoing elective surgery, with preoperative nutrition data. Patients were grouped into none/mild malnutrition and moderate/severe malnutrition based on BMI Z-scores or two-weight differences, and outcomes compared: postoperative complications, hospital length of stay (LOS), and unplanned reoperation. Sarcopenic measures based on cross-sectional imaging were collected.

Results: Ninety-three planned surgical admissions were identified; 70 in the none/mild malnutrition group and 23 in the moderate/severe malnutrition group. There were no significant differences in post-operative complication rates (38.1 % moderate/severe vs. 22.4 % none/mild, p = 0.18). The moderate/severe malnutrition group had a longer LOS (8.6 ± 4.8 days vs. 5.7 ± 2.6 days; p = 0.01) and a higher risk of unplanned reoperation (n = 8, 34.8 % vs. n = 5, 7.1 %, p = 0.03). Psoas index was significantly higher between none/mild and moderate/severe malnutrition groups (6.5 ± 1.9 vs 4.6 ± 2.0, p = 0.01).

Conclusions: Pediatric IBD patients undergoing elective surgery with moderate/severe malnutrition are at increased risk of a longer hospital LOS and unplanned reoperation. Radiographic sarcopenic measures correlate with malnutrition status based on BMI Z-scores and warrant further investigation for predicting post-operative outcomes in this population.

Level Of Evidence: IV.