Background: Malnutrition is a common cause of morbidity in children with congenital heart disease. Currently, Guatemala has one of the highest rates of chronic malnutrition globally. Therefore, we sought to assess the impact of preoperative nutritional status on clinical outcomes and hospital costs after cardiac surgery in Guatemala. We hypothesize that children with poor nutritional status pre-operatively had worse postoperative outcomes and higher hospital costs.

Methods: We retrospectively reviewed all charts of patients who underwent cardiac surgery from January 2019 to December 2020 at the Unidad de Cirugía Cardiovascular de Guatemala. Underweight was defined as weight for height z-score <-2 and stunted as height for age Z-score <-2. Descriptive analyses evaluated the percent of underweight and stunted patients preoperatively. A bivariate logistic regression model evaluated the association between underweight and stunting with the post-operative mechanical ventilation, infection, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and cost of hospital stay.

Results: A total of 187 patients, 87 (47%) males, median age of 3.7 years (interquartile range 10 months – 6.9 years) were included. Most (35, 18%) were underweight and were stunted (78, 41.7%). Compared to patients with adequate nutritional status, underweight patients were more likely to have pulmonary and infections complications (25%, p=0.05), and blood transfusion (40%, p=0.05). Stunted patients were also more likely of having cardiac complications (26%, p=0.05). Stunting was associated with longer duration of mechanical ventilation (p<0.001), ICU stay (p<0.001), hospital LOS (p=0.004), and higher cost of hospital stay (p<0.001). Compared to patients with a normal height for age, stunted patients had a six-fold increased risk of in-hospital death (p<0.001).

Conclusions: In Guatemala, a country with one of the highest prevalence of malnutrition worldwide, undernutrition and stunting were associated with higher morbidity, mortality, and hospital costs among children undergoing cardiac surgery. Strategies for improving children’s preoperative nutritional status in Guatemala are imperative to improve post-operative outcomes and reduce healthcare costs in an already vulnerable population with limited resources