Malnutrition Increases the Risk of 30-Day Complications after Surgery in Pediatric Patients with Crohn's Disease

INTRODUCTION: Pediatric patients with Crohn's disease (CD) are frequently malnourished, yet how this affects surgical outcomes has not been evaluated. This study aimed to determine the effects of malnourishment in children with Crohn's disease on 30-day outcomes after surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2012 to 2015 was used to select children aged 2 to 18 years with CD who underwent major bowel surgery. For each patient, BMI-for-age Z-scores were calculated based on CDC growth charts, and the 2015 consensus of pediatric malnutrition to categorize severity of malnutrition: none, mild, moderate, severe. Malnutrition's effects on 30-day complications, readmissions, and length of stay were compared. RESULTS: Five hundred twenty-eight patients were included. Three hundred fifty-nine (68.0%) had no malnutrition, 97 (18.4%) minor, 49 (9.3%) moderate, and 23 (4.4%) severe. There were no differences in malnutrition by age, sex, American Society of Anesthesiologists class, or elective/urgent case. The postoperative complication rate was 15.3%, with worsening malnutrition directly correlating to higher complication rates: none 12.3%, mild 18.6%, moderate 22.5%, and severe 34.8% (p = 0.01) (Figure). Readmission rate was 7.2% and did not differ by malnutrition (p = 0.24). Length of stay was increased for severe malnutrition (12 days for severe, 6 days for all other classes, p = 0.001). In multivariate analysis, moderate (odds ratio [OR] 2.19, p = 0.04) and severe malnutrition (OR 3.03, p = 0.02) were associated with increased risk of postoperative complications. CONCLUSIONS: Moderate and severe malnutrition are important risk factors in 30-day complications in children with CD undergoing major bowel surgery. Optimizing nutritional status prior to operating in this population should be considered whenever possible.Figure