Introduction

Nutritional status can affect surgical patients in terms of stress response, healing time, and outcomes. Several abnormalities are known to have a high prevalence in the general population such as vitamin D deficiency (VDD) and subclinical hypothyroidism. We hypothesized that there will be elevated rates of nutritional deficiencies in preoperative patients which may adversely affect postoperative outcomes following pediatric otolaryngology surgery.

Methods

IRB approval was obtained for a cross-sectional cohort study. Consecutive patients underwent nutritional evaluation when being scheduled for surgery including TSH, albumin and vitamin D. Demographic data, supplementation, and early complication rates were collected.

Results

125 patients were included in the final cohort with adequate demographic distribution. Based on anthropometric data, 12% of our cohort was found to be undernourished, and 40% of our cohort with elevated BMI. However, there was no relationship found between Z-scores and complications. VDD was noted in 83/125 (66.4%) patients. Our cohort had increased rates of VDD in patients with elevated BMI and African American ethnicity. Thyroid hormone abnormalities were present in 12 patients. Mean serum albumin level was 4.29 in our cohort all within normal range. We did find increased risk of postoperative complications in patients with previously diagnosed comorbidities. (p=0.006).

Conclusion

There is no current recommendation or consensus for nutritional assessment in preoperative pediatric patients. Our study did not show statistically significant correlation with z-scores, low vitamin D levels with supplementation, albumin, or TSH to postoperative complications. However, our patient cohort had higher than average rates of VDD compared to the many studies of the general pediatric population and significant negative correlation between vitamin D levels and z-scores. By early preoperative identification of VDD and supplementation with calciferol, we found no significant difference in complication rates in patients based on their initial vitamin D status. We suggest screening preoperative patients using z-score calculations and vitamin D levels based on individual patient risk factors including atrisk patient populations such as African American children, and obese children.

中文翻译：

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营养状况对小儿耳鼻咽喉头颈外科术后预后的影响

介绍

营养状况会在压力反应、愈合时间和结果方面影响手术患者。已知几种异常在一般人群中的患病率很高，例如维生素 D 缺乏症 (VDD) 和亚临床甲状腺功能减退症。我们假设术前患者的营养缺乏率会升高，这可能会对小儿耳鼻喉科手术后的术后结果产生不利影响。

方法

一项横断面队列研究已获得 IRB 批准。连续的患者在计划手术时接受了营养评估，包括 TSH、白蛋白和维生素 D。收集了人口统计学数据、补充剂和早期并发症发生率。

结果

125 名患者被纳入具有充分人口统计学分布的最终队列。根据人体测量数据，我们发现 12% 的队列营养不良，40% 的队列 BMI 升高。然而，在 Z 分数和并发症之间没有发现任何关系。在 83/125 (66.4%) 患者中注意到 VDD。我们的队列增加了 BMI 升高和非裔美国人种族患者的 VDD 发生率。12 名患者存在甲状腺激素异常。在我们的队列中，平均血清白蛋白水平为 4.29，均在正常范围内。我们确实发现先前诊断出的合并症患者术后并发症的风险增加。(p=0.006)。

结论

目前没有关于术前儿科患者营养评估的建议或共识。我们的研究未显示 z 分数、低维生素 D 水平与补充剂、白蛋白或 TSH 与术后并发症的显着相关性。然而，与针对一般儿科人群的许多研究相比，我们的患者队列的 VDD 发生率高于平均水平，并且维生素 D 水平与 z 分数之间存在显着负相关。通过术前早期识别 VDD 和补充钙化醇，我们发现基于初始维生素 D 状态的患者并发症发生率没有显着差异。