Impact of malnutrition on the outcome and length of hospital stay in elective pediatric surgical patients: prospective cohort study at tertiary hospitals in Ethiopia.

BACKGROUND: Pediatric surgical patients in low and middle-income countries suffer from malnutrition on top of the surgical pathology and post-operative stress which increases post-operative morbidity and mortality. Malnutrition is highly prevalent in Africa and is expected to impact the outcome of surgical patients. The study was aimed at determining the impact of malnutrition on the outcome and length of hospital stay in elective pediatric surgical patients.

METHODS: A prospective study was done on children, aged one month to fourteen years, who had undergone elective general surgery. Upon admission, nutritional assessment using an anthropometric indicator was undertaken and used to derive the WHO Anthro Z scores. Malnutrition was defined as a binary outcome: severely/moderately malnourished (Z < -2) versus well nourished (Z ≥ -2). After surgery, postoperative complications were documented. Chi-squared tests and t-tests were used to assess associations.

RESULTS: Of the 109 enrolled children, 49 (45%) had malnutrition preoperatively. Infants had a higher prevalence of malnutrition (65% versus 35%, p-value = 0·028) compared to older children. Postoperative infection was relatively more common in malnourished children (27·1% versus 20%). The mean post-operative stays were 5·69 days (SD 0.46) for well-nourished children and 6.89 days (SD 0·9) for malnourished patients but the difference was not statistically significant.

CONCLUSION: We observed neither significant long hospital stays nor a higher incidence of postoperative infection among children with malnutrition. Further investigations with a larger sample size are warranted.