Acute malnutrition and postoperative outcomes in pediatric abdominal surgery

Background Malnutrition is highly prevalent among surgical children in sub-Saharan Africa, but data on its association with postoperative outcomes are limited. This study presents the first dataset on malnutrition and postoperative outcomes in children undergoing major gastrointestinal (GI) surgery in Uganda. We retrospectively evaluated the association between preoperative malnutrition and postoperative outcomes in young children undergoing major GI surgery. Methods A retrospective cohort study of children aged 1–59 months who underwent major GI surgery at the Children's Surgical Hospital, Entebbe, between April 2021 and November 2024. Nutritional status was assessed at admission using WHO Z-scores and mid-upper arm circumference (MUAC) cut-offs, classifying children as stunted (height-for-age Z-score < −2) and/or wasted (weight-for-length/height Z-score < −2, or MUAC below the age-specific cut-off). Outcomes included postoperative complications (primary), complication severity, length of hospital stay, and pediatric intensive care unit admission. Multivariable regression models adjusted for demographic and clinical covariates. Results We included 274 children, 117 (42.7%) female, with a mean age of 24.5 ± 14.1 months. The most frequent diagnoses were anorectal malformations in 190 (69.3%) and Hirschsprung's disease in 64 (23.4%). At admission, 107 (39.0%) were stunted and 68 (24.8%) wasted. Overall, 95 (35.6%) experienced at least one postoperative complication, and 21 (7.7%) experienced two, resulting in a total of 116 complications. The most frequent were wound infections or dehiscence in 62 (53.4%) and urinary tract infection in 25 (21.6%). There were 6 fatalities (2.2%). After adjustment, wasting was independently associated with postoperative complications (OR 3.74; 95% CI 1.14–13.38; p = 0.03), while stunting showed no such association. Neither stunting nor wasting was associated with other outcomes. Conclusions Wasting is associated with higher odds of postoperative complications in pediatric abdominal surgery, although the confidence interval is wide. These findings underscore the need for prospective interventional studies to clarify causal relationships and determine whether targeted perioperative nutritional interventions can improve postoperative outcomes in pediatric surgical patients.