O2095: The Utility of Perioperative Nutrition Score (PONS) in Determining Outcomes in Pediatric Inflammatory Bowel Disease Patients

Background: Preoperative malnutrition is associated with increased postoperative morbidity. The perioperative nutrition score (PONS) was recently developed and can readily identify patients at risk of malnutrition based upon BMI, recent weight loss, poor nutritional intake, or hypoalbuminemia. The purpose of our study was to evaluate the utility of the preoperative PONS in assessing the perioperative outcomes of pediatric inflammatory bowel disease (IBD) patients.

Methods: We performed a retrospective cohort study of pediatric IBD patients (less than 21 years of age) that underwent elective bowel resection between June 2018 and November 2021. Patients were excluded if they had an indication for emergency surgery (i.e. acute bowel obstruction, hollow viscus perforation). Patients were divided into groups based upon whether they met PONS criteria. The primary outcome was postoperative surgical site infection. Secondary outcomes included length of stay, readmission, reoperation, ileus, and anastomotic leak. Continuous variables were tested for group differences with ANOVA and Kruskal-Wallis test, while Chi square test and Fisher’s exact test were used for categorical variables.

Results: There were 96 patients identified within the study time period. Sixty-one patients (64%) met at least one PONS criteria, while 35 patients (36%) met none (Table 1). Patients that met PONS criteria were more likely to be younger (p=.029) and male (p=.039). PONS positive patients more frequently received preoperative TPN supplementation (p <.001). There was no difference in preoperative oral nutritional supplementation between groups (6 vs 3 for PONS positive vs negative, respectively. Patients that screened positive for PONS had a longer hospital stay (p=.002), more readmissions (p=.029), and more surgical site infections (p=.002).

Conclusion: The majority of our study population met PONS criteria, highlighting the prevalence of malnutrition in pediatric IBD patients. Our data show that patients who screened positive had worse postoperative outcomes, including higher likelihood of readmission and surgical site infections. Further, very few of these patients received preoperative optimization with oral nutritional supplementation. This pilot study shows that the PONS is an effective tool to identify pediatric IBD patients at risk for worse postoperative outcomes. If validated in larger studies, the PONS could be used as an easy screening tool to optimize the preoperative nutritional state of pediatric IBD patients.