I.C. Nzenwa1, M. Kochis1, C.L. Griggs1 1Massachusetts General Hospital, Department Of Surgery, Boston, MA, USA
Introduction: Obesity is increasingly prevalent among children and adolescents and has historically been considered a risk factor for complications after surgery. Evaluating the influence of body mass index (BMI) on pediatric surgical outcomes is crucial for improving the quality of care and guiding clinical practice. We utilized a national dataset to examine the relationship between BMI and postoperative outcomes in the pediatric surgical population.
Methods: Patients under 18 years who underwent general surgical, urological, and gynecological procedures were identified using the 2012-2022 National Surgical Quality Improvement Program-Pediatric (NSQIP-P) and stratified by the American Association of Pediatrics and Centers for Disease Control and Prevention weight categories. The primary outcome was the Desirability of Outcome Ranking (DOOR) score, a composite, patient-centered ranking of 22 NSQIP-P outcomes ranging from 1 (no complication) to 6 (worst complications). Ordinal logistic regressions, adjusted for clinical risk factors, were used to examine the relationship between BMI and worse (high) DOOR scores.
Results: A total of 275,452 patients were identified (median [IQR] age, 11 [6-14] years; 45.9% female). Of these patients, 4.9% were categorized as underweight, 80.1% as normal weight, 10.0% as overweight, 3.5% as class I obesity, 0.9% as class II obesity, and 0.6% as class III obesity. Underweight children had significantly worse DOOR scores, while those who were overweight or obese had better (lower) DOOR scores (Table 1). Among patients who underwent elective general surgery, class I obesity (Odds Ratio [OR], 0.78; 95% CI, 0.69-0.88) and class II obesity (OR, 0.55; 95% CI, 0.43-0.69) were associated with better DOOR scores. Conversely, in the cohort of children who underwent non-elective general surgery, being underweight was the only significant factor linked to worse DOOR scores (OR, 1.35; 95% CI, 1.23-1.49).
Conclusion: Extremely low but not high BMI was found to be significantly associated with the least desirable postoperative outcomes in pediatric populations. While the specific drivers of this relationship remain unclear, these findings suggest that elevated BMI should not be viewed as a risk factor for surgical complications in children and adolescents and, therefore, should not be a deterrent to surgical management.