Preoperative nutritional assessment in visceral surgery units in university hospital of Antananarivo, interest of nutritional grade

Aim: The aim of the study was to determine the factors of malnutrition and the nutritional grade of patients in visceral surgery units in a Malagasy University Hospital. This aim was established because pre-operative malnutrition is an independent risk factor for postoperative complications, especially in terms of morbidity and mortality that should be assessed before any intervention. Materials and methods: A cross-sectional study, involving patients admitted for surgical intervention, in visceral surgery units, was conducted over a 12-month period. A briefing of visceral surgery staff was carried out and a survey was prepared. Correlation and regression tests were performed (SPSS® 17.0). Results: One hundred and six cases were analyzed (study population aged 46 [15–83] years old, mostly women). High morbidity planned surgeries were estimated in 32% of cases especially surgery for neoplasias. According to the body mass index (21.9 [12.8-33.3] kg/m2), malnutrition was clinically relevant in 33% of cases. Thinning was found in 35% of patients. The most frequently identified risk factors were persistent preoperative pain, neoplasia and eating disorders. Nutritional risk stratification found a majority of patients in nutritional grades I (26%) and II (42%). Nutritional grades III and IV, requiring nutritional strategies, were found in 12% and 19% of patients, respectively. Conclusion: There's many risk factors for malnutrition that can lead to clinically relevant malnutrition. Nutritional assessment should be performed before any surgical procedure in order to implement appropriate nutritional management. Following this study, an improvement of the practices should be performed in the different surgery units.