Prevalence of Malnutrition and Its Impact on Clinical Outcome in Elective General Surgical Patients at Kenyatta National Hospital

Abstract

Background Malnutrition has long been associated with negative post-operative outcomes such as delayed recovery times, higher complications rates, higher rates of morbidity and mortality, elevated readmission rates, lengthened hospitalization and increased cost of health care. In our set-up, there are no studies on prevalence and impact of malnutrition on surgical outcomes. Objectives The aim of this study was to determine the prevalence of malnutrition and its impact on clinical outcomes in elective general surgical patients at the Kenyatta National Hospital (KNH). Methodology This was a descriptive observational study conducted in KNH general surgical wards for three months. Adult 18 years and above who were admitted for elective general surgical procedures were recruited by consecutive sampling until the sample size of one hundred and five was achieved. The Patients were evaluated within 24hrs after admission using Subjective Global Assessment (SGA) tool. Data collected included demographics, anthropometric and laboratories measurement, and subjective nutritional habits. The principal investigator and a trained research assistant performed clinical assessment of the patients and filled the study questionnaire/tool. The research assistant was a medical officer trained on how to use the SGA tool. Data was entered, cleaned and analyzed using of SPSS version 21 Chicago Illinois for means, proportions, frequencies as well bivariate analysis using Chi-square and Odds ratio. A P value <0.05 was considered statistically significant. Results One hundred and five (105) patients were recruited. The mean age was 41.1 (SD=15.3) years. Overall prevalence rate of malnutrition was at 36.2%. Severe malnutrition was noted in 15.2%. The overall complication rate was 30.5%, majority (56.3%) of the complications were wound

infections. There was significant association between complications and nutritional status of the patients (p=0.005). The mean length of stay was 8.6 (SD=8.4) days, while the median was 5 (IQR=6) days. There was statistical difference between those malnourished and those well-nourished on independent sample t-test with p-value of 0.001. Malnourished patients had a significantly longer LOS. Conclusion Malnutrition is common in surgical patients admitted at Kenyatta National Hospital and is associated with poor surgical outcomes. Therefore, nutritional screening, assessment and management should be an integral part in the care of the surgical patient.