Congenital heart disease
The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR)

https://doi.org/10.1016/j.jtcvs.2013.03.023Get rights and content
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Objective

The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD).

Methods

Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject’s preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought.

Results

Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels.

Conclusions

Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.

Abbreviations and Acronyms

BMI
body mass index
BNP
B-type natriuretic peptide
CHD
congenital heart disease
CI
confidence interval
CPB
cardiopulmonary bypass
ICU
intensive care unit
LOS
length of stay
PCICU
pediatric cardiac intensive care unit
UCSF
University of California at San Francisco
UNICAR
La Unidad de Cirugia Cardiovascular de Guatemala
WHO
World Health Organization
TSFZ
triceps skin-fold-for-age z score

CTSNet classification

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Cited by (0)

This research was supported in part by HL61284 (to J.R.F.), HD049303 (to J.R.F.), K23 HL079922 (to R.L.K.), the Pulmonary Hypertension Association (to R.L.K.), the National Institutes of Health (UL RR024131) and the Unidad de Cirugia Cardiovascular de Guatemala.

Disclosures: Authors have nothing to disclose with regard to commercial support.