Aims & Objectives:
Suboptimal nutritional state has been associated with increased morbidity and mortality in children after congenital heart surgery. This study evaluates impact of pre-operative nutritional status on outcomes after paediatric congenital heart surgery.
We included children under 10 years old who underwent congenital heart surgery at a tertiary children’s hospital from 2010 to 2016. Patients who had patent ductus arteriosus ligation only, genetic syndromes or global developmental delay were excluded. Outcome measures include intensive care unit (ICU) length of stay (LOS) and 30-day mortality.
425 children of median age 15.1 [interquartile range (IQR) 2.9,48.5)] months were included. Most common cardiac lesions were ventricular septal defect (n=125, 29.4%), atrial septal defect (n=71, 16.7%) and Tetralogy of Fallot (n=63, 14.8%). Median weight-for-age Z score (WAZ) was -1.34 (IQR -2.29,-0.58).
Patients with normal WAZ between -2 to <2 (n=276, 64.9%) had shorter median ICU LOS [2.0 (IQR 1.0,3.8) vs. 3.0 (IQR 2.0,7.0) days, p=0.027] and lower 30-day mortality [3 (1.1%) vs. 10 (7.2%), p=0.012] than patients with WAZ <-2 (n=139, 32.7%).
After adjusting for age, RACHS-1 score, cyanosis, comorbidities and number of inotropes used, WAZ <-2 was associated with higher risk of ICU LOS of more than 3 days [adjusted odds ratio (OR) 2.0, 95%CI 1.1–3.7] and higher risk of 30-day mortality (adjusted OR 6.9, 95%CI 1.5–29.6), when compared to patients with WAZ between -2 to <2.
We demonstrated that WAZ <-2 is associated with longer ICU LOS and higher risk of 30-day mortality. Future studies examining impact of pre-operative nutritional optimisation are warranted.