Risk factors and simple scoring system for predicting postoperative nutritional status of Hirschsprung's disease

Front Nutr. 2024 Dec 6:11:1441104. doi: 10.3389/fnut.2024.1441104. eCollection 2024.

Abstract

Background: Nutritional problem after surgery for Hirschprung's disease (HSCR) was not optimistic. This study aimed to analyze the risk factors of postoperative undernutrition for patients with HSCR and establish a scoring system for predicting postoperative undernutrition.

Methods: Retrospective review of 341 patients with HSCR who received Laparoscopic-assisted pull-through surgery in a tertiary-level pediatric hospital was conducted with assessments of clinical data. Univariate/multivariate Logistic regression analysis was used to identify independent factors of postoperative undernutrition, and establish a scoring system for predicting postoperative nutritional status based on the sum of adjusted odds ratios (ORs).

Results: The postoperative undernutrition of 341 patients with HSCR was 29.9%. Multivariate Logistic regression analysis showed that non-breast feeding (mixed: OR = 6.116, artificial: OR = 12.00), preoperative undernutrition (risk of malnutrition: OR = 7.951, malnutrition: OR = 8.985), non-parental caregivers (OR = 3.164), long-segment HSCR (OR = 12.820), postoperative complications within 30 days (grade 1 ~ 2: OR = 2.924, Grade 3 ~ 4: OR = 6.249), and surgery for other systemic malformation (OR = 5.503) were risk factors for postoperative undernutrition (all p < 0.05), and scoring system was developed based on these determinants. The area under the receiver operator characteristic curve of the derivation sample was 0.887 (95% confidence interval [CI]: 0.839-0.934) and that of the validation sample was 0.846 (95% CI: 0.772 ~ 0.920) with the optimal cut-off value of 12; calibration curves of the derivation sample showed considerable predictive performance for postoperative undernutrition.

Conclusion: Risk factors identified affecting postoperative undernutrition should be taken seriously in patients with HSCR. We successfully developed a desirable scoring system to predict postoperative nutritional status, which might be helpful for clinical practice.

Keywords: Hirschprung’s disease; prediction; risk factor; scoring system; undernutrition.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by research grants from the National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University (No. NCRCCHD-2022-GP-03) and Program for Youth Innovation in Future Medicine, Chongqing Medical University (No. W0125).