Preoperative nutrition status in children with congenital heart disease and its impact on postoperative outcomes: a systematic review and meta-analysis

Despite the significant advancement in congenital heart disease (CHD) surgery over the years, the mortality and morbidity rate in children undergoing CHD surgery is substantial, especially in lower-middle-income countries. Evidence shows that malnutrition contributes to morbidity and mortality in these children, with a negative impact on their surgical outcomes. The aim of this systematic review and meta-analysis was to assess the impact of preoperative nutritional status on postoperative outcomes among patients with CHD. PubMed, Embase, Scopus, CINAHL, ProQuest, and the Cochrane Library were searched from January 1, 2000, to Mar 1, 2024. Twenty-one studies were included in the review with 22,621 malnourished and 60,402 well-nourished children undergoing CHD surgery. Malnourished children had a significantly longer LOS in the hospital, with a standard mean difference (SMD) of 0.49 [95% confidence interval (CI) 0.09-0.88] days, a longer ICU stay (SMD 0.51 [95% CI 0.16-0.86] days), a higher RACHS-1/STAT score (SMD 1.72 [95% CI 1.32-2.25]), and a higher mechanical ventilation time (SMD 0.46 [95% CI 0.18-0.74] hours). However, there was no significant difference in mortality, with an odds ratio (OR) of 1.82 [95% CI 0.94-3.5], and postoperative infection rates (OR 1.27 [95% CI 0.05-35.02]) between the malnourished and well-nourished groups. Malnourished children undergoing CHD surgery experience significantly worse postoperative outcomes in terms of hospital and ICU stay, and mechanical ventilation time. Efforts to improve preoperative nutritional status could potentially enhance these outcomes.