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Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery

Published online by Cambridge University Press:  19 June 2017

Faith Ross Open the ORCID record for Faith Ross [Opens in a new window] ,
Gregory Latham ,
Denise Joffe ,
Michael Richards ,
Jeremy Geiduschek ,
Michael Eisses ,
Douglas Thompson  and
Monique Radman
Faith Ross*
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Gregory Latham
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Denise Joffe
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Michael Richards
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Jeremy Geiduschek
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Michael Eisses
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Douglas Thompson
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Monique Radman
Affiliation:
Critical Care, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
*
Correspondence to: F. Ross, MD, Anesthesiology and Pain Medicine, 4800 Sandpoint Way NE MB.11.500, Seattle, WA 98105, United States of America. Tel: (206) 987-3996; Fax: (206) 987-3935; E-mail: faith.ross@seattlechildrens.org
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Abstract

Background

Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery.

Methods

We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children’s Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes.

Results

We found a non-linear relationship between low height-for-age and weight-for-age z-scores and mortality after surgery. In the range of z-score ⩽−2, each additional unit decrease in height-for-age or weight-for-age z-score was associated with a 2.9 or 2.1% increased risk for mortality, respectively. Each unit decrease in height-for-age z-score was associated with a 1.2% increased risk for cardiac arrest, 1.1% increased risk for infection, and an average of 1.7 additional hours of mechanical ventilation, 6 hours longer ICU stay, and 13 hours longer hospital stay. Each unit decrease in weight-for-age z-score was associated with a 0.7% increased risk for cardiac arrest, 0.8% increased risk for infection, and an average of 1.9 additional hours of mechanical ventilation and 5.3 additional hours of ICU stay.

Conclusions

This study is unique in demonstrating a significant association between malnutrition and 30-day mortality and other adverse outcomes after paediatric cardiac surgery in a mixed population of CHD patients. By evaluating nutritional status as a continuous variable, we were able to clearly distinguish the point at which malnutrition begins to affect mortality.

Keywords

NutritionmalnutritionCHDcongenital cardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1716 - 1725
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Copyright
© Cambridge University Press 2017 

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Footnotes

Approved by the Seattle Children’s Hospital IRB on 12 February, 2016.

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