O3297: Preoperative Indicators of Nutritional Status and Outcomes Among Pediatric Cancer Patients Undergoing Surgery

Background: Poor nutrition is a risk factor for surgical complications and pediatric cancer patients are at an increased risk of malnutrition. However, while there are several indices that have been used as markers for nutritional status, the most accurate indicators of poor preoperative nutrition and predictors of increased risk for nutrition-related postoperative complications have not been well-established. This study aims to determine which preoperative indicators of nutritional status are most predictive of postoperative complications in pediatric cancer patients.

Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database. Pediatric patients with an active cancer diagnosis at the time of pediatric general surgical intervention from 2015 to 2019 were reviewed. Those without preoperative albumin levels or height and weight measurements were excluded. Patients were separated into groups on the basis of preoperative albumin level greater or less than 3 g/dL, preoperative nutritional support requirement, and body mass index (BMI) percentile. BMI was calculated using the Centers for Disease Control and Prevention BMI-for-Age percentile calculator and patients were then grouped into the following BMI percentile ranges for comparison: underweight ( < 5th percentile), normal (5th-85th percentile), overweight (85th-95th percentile), and obese (≥95th percentile). Statistical analysis was performed using Pearson Chi-Square, Fisher’s Exact Test, Student's t-test, and multiple logistic regression.

Results: 3442 pediatric cancer patients who underwent a pediatric general surgical procedure from 2015 to 2019 were identified. 39% of patients had a BMI percentile outside of normal range (10.3% underweight, 13.2% overweight, and 15.5% obese), 10.6% had a preoperative albumin level of less than 3 g/dL, and 14.3% required nutritional support prior to surgery. Patients who possessed one or more of these indicators of poor nutritional status had an increased risk of postoperative complications (p=0.0132). On multivariable analysis, preoperative albumin level less than 3 g/dL was associated with an increased risk of infectious complications (p=0.0162), increased ventilator days (p < 0.0001), increased postoperative length of stay (p < 0.0001), and decreased 30-day survival (p=0.0198). Obesity was associated with increased ventilator days (p=0.0021). Preoperative nutritional support requirement was not independently associated with an increased risk of postoperative complications.

Conclusion: Pediatric cancer patients undergoing surgical intervention are at an increased risk of operative complications related to poor nutritional status. Albumin less than 3 g/dL was the strongest independent predictor of postoperative complications, including increased 30-day mortality. Nutritional status should be carefully considered during operative planning for children with cancer and preoperative albumin levels may be useful in predicting which children are at an increased risk of nutrition-related complications.