Preoperative Malnutrition Increases Risk of In-Hospital Mortality, Major Infection, and Longer Intensive Care Unit Stay After Ventricular Septal Defect Closure.

Abstract

High energy requirements and poor feeding can lead to growth failure in patients with ventricular septal defect (VSD), but effects of preoperative malnutrition on surgical outcomes are poorly understood, especially in low-resource settings. We analyzed a cohort of children <5 years of age undergoing VSD closure at 60 global centers participating in the International Quality Improvement Collaborative for Congenital Heart Disease, 2015 to 2020. We calculated adjusted odds ratios (ORs) for in-hospital death and major infection and adjusted coefficients for duration of intensive care unit stay for 4 measures of malnutrition: severe wasting (weight-for-height Z score, <-3), moderate wasting (-3<weight-for-height Z score≤-2), underweight (weight-for-age Z score, ≤-2), and stunting (height-for-age Z score, ≤-2) according to World Health Organization Child Growth Standards. Among 10 966 children undergoing VSD closure in the analyzed cohort, 8136 (74%) were membranous VSDs. Median age was 9.6 months (interquartile range, 3.6-12.0), and 4088 (37.3%) had wasting/severe wasting, 5029 (45.9%) had underweight, and 3515 (32.1%) had stunting. There were 4749 (43.3%) children who met the criteria for ≥2 malnutrition categories. Overall, 84 patients (0.8%) died in-hospital, and 199 (1.8%) had major infection. Severe wasting (OR, 3.38 [95% CI, 1.55-7.35]; P=0.002), underweight (OR, 6.46 [95% CI, 2.81-14.8]; P<0.001), and stunting (OR, 2.73 [95% CI, 1.40-5.34]; P=0.003) were independent predictors of mortality. Similar results were observed for infection and duration of intensive care unit stay. Underweight was the strongest predictor of adverse outcomes. Children meeting criteria for all 3 (stunting, wasting, and underweight) had 17.2 times higher odds of mortality (P<0.001) than nonmalnourished children. Malnutrition was associated with mortality, infection, and longer intensive care unit stay in a global cohort of children undergoing VSD closure.