The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery

Abstract

Undernutrition is common in surgical patients, is frequently unrecognised and is strongly associated with adverse outcomes such as high rates of complications and mortality, worsening functional status and prolonged hospitalisation. Owing to the associated infection and symptoms such as repeated vomiting, a high prevalence of undernutrition is expected in hydrocephalus patients, which may contribute to their poor surgical outcomes. The aim of this study was to evaluate the influence of preoperative nutritional status on the outcome of Indian patients with hydrocephalus undergoing neurosurgical shunt surgery. One hundred and twenty-four consecutive patients undergoing scheduled hydrocephalus shunt surgery were studied prospectively. All patients underwent nutritional screening according to different parameters prior to surgery. The patients were classified into normally nourished and undernourished groups. The undernourished group was further subdivided into moderately and severely undernourished. The surgical outcome was compared between these groups. A high prevalence (53 %) of undernutrition was observed in these patients. Postoperative complications such as shunt infection (P¼0·0023), shunt revision (P¼ 0·0074) and mortality (P¼ 0·0003) were significantly more common in undernourished patients compared with normally nourished patients. Serum albumin emerged as the most significant independent predictor of postoperative mortality. The present study demonstrated a high prevalence of undernutrition in hydrocephalus patients in India and its adverse influence on the outcome of shunt surgery. Early preoperative nutritional status screening and its optimisation may decrease the morbidity and mortality of shunt surgery for hydrocephalus. Nutritional status: Hydrocephalus: Neurosurgical shunt surgeryThe influence of nutritional status on the course of an illness was already known to Hippocrates when he stated that well-fed patients would recover more quickly 1 . Since then, numerous studies have widely acknowledged the deleterious effects of impaired nutritional status on clinical outcome 2 -4 and hospital costs 5 . Undernutrition, however continues to be a significant problem in surgical patients, with up to 40 % of patients being undernourished on admission to hospital, and about 78 % of the undernourished patients who stay longer in hospital losing further weight 6 -8 .This deterioration of nutritional status in the patient undergoing surgery may result in reduced systemic immunity, an exaggerated stress response, organ system dysfunction, poor wound healing and delayed functional recovery 7,9 -14 . Therefore, careful preoperative nutritional assessment followed by the initiation of appropriate nutritional therapies has been proposed to improve outcomes 12 . Hydrocephalus is a clinical condition marked by the excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It is more frequent in children and results from congenital or acquired disease processes including developmental anomalies, neop...

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Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus

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Missed Opportunities for Nutritional Rehabilitation in Children Admitted to Surgical Wards

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