Impact of perioperative nutritional status on the outcome of abdominal surgery in a sub-Saharan Africa setting

Abstract

Background: Malnutrition is a clinical condition of multifactorial etiologies and it is associated with several adverse outcomes. In high-income countries, malnutrition has been described as a determinant of delayed wound healing, surgical site infections and mortality in the postoperative period. There is limited information available regarding the outcome of surgery in malnourished patients in sub-Saharan Africa. Methods: A cross-sectional analytic study was carried out between March and August 2014 in the visceral surgery and the emergency departments of the Yaounde Central Hospital in Cameroon. All consecutive consenting preoperative and postoperative patients of abdominal surgical procedures were enrolled. Variables studied were: socio-demographic characteristics, medical and surgical past histories, nutritional survey, anthropometric parameters and serum albumin level in order to determine the nutritional risk index (or Buzby score). Results: A total of 85 patients aged from 19 to 50 years with mean age of 34.4 ± 8 years were included. The most performed abdominal surgical procedure was appendectomy (30.6%). The prevalence of preoperative malnutrition according to the Buzby score was 39.1%. Mean postoperative weight lost was 2.9 ± 1.2 kg and mean decrease in postoperative serum albumin was 4.2 ± 0.2 g. A normal postoperative serum albumin was associated with a favorable outcome [OR (95% CI) = 55 (13.4-224.3), p < 0.001]. Conclusions: The prevalence of malnutrition is high in our visceral surgery and emergency departments; this is associated with an increased risk of adverse early postoperative outcomes. Overall, our results emphasize the need of optimizing perioperative care through routine nutritional assessment and management of surgical patients in Cameroon.