Preoperative Malnutrition Among Patients Scheduled for Elective Gastrointestinal Surgery at a National Hospital in Tanzania

Abstract

Background: Malnutrition is a critical but under recognized factor contributing to poor surgical outcomes, particularly in low resource settings. In sub-Saharan Africa, data on preoperative malnutrition among patients undergoing gastrointestinal (GI) surgeries are scarce. Therefore, this study aimed to determine the proportion of preoperative malnutrition and its associated factors among adults scheduled for major GI surgeries at the national hospital in Tanzania
Methods: We conducted a cross sectional study involving 143 adult patients who were scheduled to undergo major GI surgeries at Muhimbili National Hospital between August 2023 and January 2024. Nutritional status was assessed using body mass index (BMI) and serum albumin levels. We used the nutritional risk index (NRI) as a proxy estimate of postoperative complications. Sociodemographic and clinical data were analyzed using SPSS version 26. Associations with malnutrition were examined using the chi-square and Fisher’s exact tests.
Results: Thirty six percent (n=52) of patients were malnourished based on at least one indicator. Overall, 22.4% (n=32) of patients were undernourished, whereas 14.0% (n=20) were classified as overnourished. Overweight and obesity (BMI > 24.9 kg/m²) were present in 14% (n=20) of the patients, while 2.1% (n=3) were underweight (BMI < 18.5 kg/m²). Low serum albumin levels (<35 g/L) were noted in 22.4% (n=32) of the cases. Using the NRI as a proxy measure for postoperative complications, 44.1% (n = 63) of patients were classified as having moderate-to-severe risk. Malnutrition was significantly associated with American Society of Anesthesiology Physiological Status class III (p=.007), illness duration of ≥28 days (P=.042), hypertension (P=.004), and severe anemia (P=.002).
Conclusion: Preoperative malnutrition is common among patients undergoing elective GI surgery, with undernutrition being the most prevalent. Nutritional screening and prehabilitation should be integrated into routine perioperative care to improve surgical outcomes.