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
•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