A. T. Train1, S. Cairo1, H. A. Meyers1, C. M. Harmon1,2, D. H. Rothstein1,2 1Women And Children’s Hospital Of Buffalo,Pediatric Surgery,Buffalo, NY, USA 2State University Of New York At Buffalo,Buffalo, NY, USA
Introduction:
Patient obesity has been implicated as a causative factor for surgical site infection and other surgical complications in adult patients. We sought to examine the effects of obesity on specialty-specific surgical outcomes in children.
Methods:
Retrospective cohort study using the Pediatric National Surgical Quality Improvement Program, 2012-2014. Patients included those aged 2-18 years who underwent a surgical procedure in one of the following categories: general surgery, neurosurgery, orthopedic surgery, otolaryngology, plastic surgery or urology. Obesity (body mass index ≥ 95th percentile, adjusted for age and gender) was the primary predictor of interest. Outcomes of interest were post-operative complications (wound complications, non-wound complications, and composite overall morbidity) and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis after adjustment for demographics and comborbidities.
Results:
When examining all operated patients, obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI: 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI: 0.63–0.73) and overall morbidity (OR 0.79, 95% CI: 0.75–0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing neurosurgery, otolaryngology, or plastic surgery procedures (Table). Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures.
Conclusion:
Obesity confers an increased risk of wound complications in some but not all pediatric surgical specialties, and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure or specialty-related factors than previously suspected. Future research should attempt to identify these factors and how they may be potentially protective against obesity-related surgical complications.
