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Body Mass Index Percentile and Surgical Outcomes in Children From the National Surgical Quality Improvement Program Pediatric 2012

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BMI percentile and surgical outcomes in children from the National Surgical Quality Improvement Program Pediatric 2012

Kefu Du, M.D., Chong Zhang, M.S., Angela P. Presson, Ph.D., Patrick C. Cartwright, M.D., M. Chad Wallis, M.D. 


To evaluate the importance of obesity and underweight as measured by BMI percentile on 30-day perioperative outcomes by analyzing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric data for 2012


Study cohort: 29,016 nonbariatric surgical procedures for children age 2 to 18 years in 2012
CDC weight classes based on BMI percentile for age and gender

Underweight (< 5th), healthy weight (5th to 85th), at-risk for overweight (85th to < 95th), overweight (≥ 95th)

Compared variables’ distributions across the four weight classes


No difference in 30-day mortality across the weight classes (p = 0.48)

Underweight children trended toward a higher morbidity (OR = 1.19; 95%-CI 1.00-1.42, p = 0.15)
Overweight children trended toward a lower morbidity (OR = 0.87; 95%-CI 0.76-0.99, p = 0.12) 




Underweight (< 5th percentile)

Higher ASA class
ventilator and/or oxygen support blood transfusions
neurologic, cardiac, pulmonary, GI, hematologic, and nutritional risk factors.

Inpatient at time of surgery More complex surgery
Longer operative time
Longer anesthesia reversal time

Renal complications
Blood transfusions
Reoperation and readmission Longer length of hospital stay

Overweight (≥ 95th percentile)

Ventilator/oxygen support Hepatobiliary risk factors Diabetes
Lower risk for neurologic, cardiac, GI, immunologic, and nutritional risk factors

More urgent or emergent surgeries

Fewer blood transfusions More superficial surgical site infections 


Underweight pediatric surgical patients have a higher rate of comorbidity, undergo more complex and longer surgeries, and are at higher risk for unplanned reoperations and readmissions, longer hospital stay, and postoperative morbidity.

Overweight children are at higher risk for superficial surgical site infections but appear to be protected from other postoperative complications.

Abbreviations BPD: Bronchopulmonary dysplasia, CI: Confidence interval, CLD: Chronic lung disease, CPR: Cardiopulmonary resuscitation, EGI: Esophageal/ gastric/intestinal disease, FTT: Failure to thrive, LBP: Liver/biliary/pancreatic disease, RRT: Renal replacement therapy, SIRS: Systemic inflammatory response syndrome, SPA: Structural pulmonary/airway abnormalities, SSI: surgical site infection