Worsening degrees of malnutrition are directly linked to a higher risk of 30-day complications in children with Crohn’s disease who have undergone major bowel surgery, a study says.
The study, “Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease,” appeared in the Journal of Pediatric Surgery.
Although there is no cure for Crohn’s disease (CD), children with this condition may benefit from surgical removal of the affected intestine parts, a strategy that can improve the child’s growth and development.
Studies have previously shown that malnourishment in adult CD patients is associated with a higher risk for post-surgery complications. This study’s authors believe no similar evaluation has been done on children with the disease.
A group of researchers from the Johns Hopkins University School of Medicine explored the outcomes of CD pediatric patients’ surgeries and how they correlated to the children’s nutritional status.
A total of 516 patients with a median age of 15.5 years were evaluated, using data collected by the American College of Surgeons for the National Surgical Quality Improvement Program Pediatric Registry (NSQIP-P).
Selected patients, diagnosed with CD, underwent major bowel surgery — 45.5% of them had an ileocecectomy (surgical removal of the ileum, the final section of the small intestine). In this group, there were 68 post-surgery complications (13.2%), 27 reoperations (5.2%) and 36 readmissions (7.0%).
The team used the body mass index (BMI)-for-age Z scores, based on the Centers for Disease Control and Prevention guidelines, in order to classify each patient’s nutritional status. The results showed 67.6% of patients were not considered malnourished, and 18.8% had mild, 9.5% moderate, and 4.1% severe malnutrition.
The authors found a significant correlation between the levels of malnutrition and post-surgery complications, but no link was found between malnutrition and hospital readmissions.
Data showed that the rate of complications increased with worsening malnutrition. In the group of severely malnourished children, there was even a higher rate of association with sepsis (systemic infection) and the prolonged use of parenteral nutrition — when the gut cannot absorb nutrients, a solution containing amino acids, glucose, fat, electrolytes, trace elements, and vitamins is delivered into the bloodstream, bypassing the gut.
Levels of albumin, a blood protein, often correlate with nutritional status. However, according to the American Society for Parental and Enteral Nutrition (ASPEN), the use of albumin is not recommended to evaluate nutritional status in Crohn’s patients, since the decrease of this protein occurs in acute disease phases.
In this study, the BMI-for-age reference was not able to predict risk of complications in patients with low albumin levels. But in those patients without active disease and needing surgery, serum albumin analysis could be of benefit because it may indicate malnourishment.
“Using BMI-for-age z-scores is a useful screening tool for malnutrition but does not provide the complete picture for a patient’s nutritional status which is influenced by active disease including inflammation, malabsorption, or effects from disease treatment including steroids and immunosuppressive agents,” the researchers wrote.
“Further studies are needed to determine whether BMI-for-age-z scores can be used to guide nutritional optimization before major surgery in this population.”
The results showed that “worsening degrees of malnutrition directly correlate with increasing risk of 30-day complications in children with CD undergoing major bowel surgery. This study suggests that malnourished pediatric CD patients should have their nutritional status optimized prior to surgery when possible,” the authors concluded.