Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov;53(11):2336-2345.
doi: 10.1016/j.jpedsurg.2018.04.026. Epub 2018 Apr 27.

Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease

Mitchell R Ladd  1 , Alejandro V Garcia  1 , Ira L Leeds  1 , Courtney Haney  2 , Maria M Oliva-Hemker  3 , Samuel Alaish  1 , Emily Boss  4 , Daniel S Rhee  5
Affiliations

Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease

Mitchell R Ladd et al. J Pediatr Surg. 2018 Nov.

Abstract

Background: Pediatric patients with Crohn disease (CD) are frequently malnourished, yet how this affects surgical outcomes has not been evaluated. This study aims to determine the effects of malnourishment in children with CD on 30-day outcomes after surgery.

Study design: The ACS NSQIP-Pediatric database from 2012 to 2015 was used to select children aged 5-18 with CD who underwent bowel surgery. BMI-for-age Z-scores were calculated based on CDC growth charts and 2015 guidelines of pediatric malnutrition were applied to categorize severity of malnutrition into none, mild, moderate, or severe. Malnutrition's effects on 30-day complications. Propensity weighted multivariable regression was used to determine the effect of malnutrition on complications were evaluated.

Results: 516 patients were included: 349 (67.6%) without malnutrition, 97 (18.8%) with mild, 49 (9.5%) with moderate, and 21 (4.1%) with severe malnutrition. There were no differences in demographics, ASA class, or elective/urgent case type. Overall complication rate was 13.6% with malnutrition correlating to higher rates: none 9.7%, mild 18.6%, moderate 20.4%, and severe 28.6% (p < 0.01). In propensity-matched, multivariable analysis, malnutrition corresponded with increased odds of complications in mild and severely malnourished patients (mild OR = 2.1 [p = 0.04], severe OR 3.26 [p = 0.03]).

Conclusion: Worsening degrees of malnutrition directly correlate with increasing risk of 30-day complications in children with CD undergoing major bowel surgery. These findings support BMI for-age z scores as an important screening tool for preoperatively identifying pediatric CD patients at increased risk for postoperative complications. Moreover, these scores can guide nutritional optimization efforts prior to elective surgery.

Level of evidence: IV.

Keywords: Inflammatory bowel disease; Malnutrition; Nutrition; Pediatric Crohn disease; Surgery outcomes.

PubMed Disclaimer

Figures

Figure A3.1.
Figure A3.1.
Plotted Balance Metrics for Absolute Standardized Mean Differences (“es.mean”) and Kolmogorov-Smirnov Statistic (“ks.mean”) Demonstrating Asymptotic Approach to Optimal Balance
Figure A3.2.
Figure A3.2.
Propensity Score Distributions of Each Malnutrition Category on the Four Others Demonstrating Appropriate Non-Zero Overlap Between All Groups
Figure A3.3.
Figure A3.3.
Comparison of Overall Absolute Standardized Mean Difference of Covariates Between Malnutrition Groups Before and After Propensity Score Weighting
Figure A3.4.
Figure A3.4.
t- and Chi- square p-values for Differences in Covariates between Malnutrition Groups Before (solid dot) and After (hollow dot) Propensity Score Weighting
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Diederen K, de Ridder L, van Rheenen P, Wolters VM, Mearin ML, Damen GM, et al. Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohnʼs Disease. Inflamm Bowel Dis 2017;23:272–82. doi:10.1097/MIB.0000000000000999. - DOI - PubMed
    1. Amil-Dias J, Kolacek S, Turner D, Pærregaard A, Rintala R, Afzal NA, et al. Surgical Management of Crohn Disease in Children - Guidelines from the Paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr 2017;64:1. doi:10.1097/MPG.0000000000001562. - DOI - PubMed
    1. Efron JE, Young-Fadok TM. Preoperative Optimization of Crohn Disease. Clin Colon Rectal Surg 2007;20:303–8. doi:10.1055/s-0033-1348044. - DOI - PMC - PubMed
    1. Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P. Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: A multivariate analysis in 161 consecutive patients. Dis Colon Rectum 2007;50:331–6. doi:10.1007/s10350-006-0782-0. - DOI - PubMed
    1. Vernier-Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, et al. Natural History of Pediatric Crohn’s Disease: A Population-Based Cohort Study. Gastroenterology 2008;135:1106–13. doi:10.1053/j.gastro.2008.06.079. - DOI - PubMed

Supplementary concepts