Prospective Analysis of Pre-Operative Nutritional Indices and Micronutrients Affecting Outcome in Children Undergoing Surgery

Document Type : Original Article


Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India


Background: Optimum nutrition is necessary for a child’s growth, development and recovery from illness or disease. This study has analysed pre-operative nutritional indices and micronutrients affecting outcome in children undergoing surgery.
Methods: In a prospective observational cohort study at a tertiary pediatric surgery center, 186 children aged three months to 17 years and planned for major elective surgery were recruited. Height for age, weight for age, midarm circumference, and triceps skin fold thickness were measured. Blood samples were drawn for albumin, prealbumin, transferrin, iron, ferritin, vitamin B12, zinc, folate, calcium, and vitamin D. The development of nutritional-associated complications were recorded too.
Results: Stunting was seen in 42.9%, while 28.2% needed blood transfusion, 7.1% required total parenteral nutrition, and 2.2% needed ventilator support. Totally, 19.5% developed wound infection and 8.7% required redo surgery. An association of zinc with incidents [OR=0.826, 95% CI: (0.708, 0.964)], folate with the need for transfusion [OR=0.92, 95% CI: (0.85, 0.99)], and serum iron with a need for total parenteral nutrition [OR=0.98, 95% CI: (0.95, 1.00)] was noticed. Triceps skin fold thickness was correlated with the length of stay and underweight with a need for transfusion, while stunting had no impact on outcomes.
Conclusion: The prevalence of malnutrition in children undergoing surgery was significant. Zinc was associated with adverse outcomes; while folate with the need for a blood transfusion. Underweight and triceps skin fold thickness had predictive potential. It seems that preoperative identification and correction of these micronutrients deficiency before surgery may help in improving the outcomes.