Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes

Abstract

Background/Purpose Pediatric obesity is an important public health concern, yet its effect on surgical outcomes is poorly understood. The purpose of this study was to determine if age and gender-specific body mass index (BMI) percentile influences complications and hospital resource utilization following pediatric gastrointestinal surgeries. Methods Patients aged age ≥2 to <18 years who underwent appendectomy or other gastrointestinal operations were identified in the 2012 - 2013 Pediatric National Surgical Quality Improvement Program datasets. Age- and gender-specific pediatric BMI percentiles were calculated. Patients who underwent appendectomy (n=9,606) and those undergoing all other intestinal operations (n=2,664) were evaluated as separate cohorts. Results In the appendectomy cohort, frequency of any complication increased with BMI category (normal-weight 4.5%, overweight 5.3%, obese 5.7%, morbidly obese 7.3%, overall 5.0%, p = 0.014). In multivariable analysis, there was a quadratic association between BMI percentile and increased frequency of superficial incisional infection, unplanned tracheal intubation, and longer operative duration. In the intestinal surgery cohort, BMI percentile was not a predictor of any individual complication or any measure of hospital utilization. Conclusions Age- and gender-specific BMI percentile was associated with increased risk of complications and longer operative duration in patients undergoing appendectomy but not other intestinal operations.

Appendectomy Hospital Stay: No Difference in Obese Adult or Pediatric Patient Length of Stay Compared to Nonobese Patients

“… 4 A study of a large national pediatric database that compared patients who underwent appendectomy to patients undergoing other intestinal operations showed that obese appendectomy pediatric patients had significantly longer hospital LOS compared nonobese patients, but no significant difference in LOS was seen between obese and nonobese patients undergoing other intestinal operations. 5 Other studies have reported worse outcomes in obese adults and longer operating times in obese adults and children. 6 - 8 The purpose of this study was to investigate the effect of obesity in adult and pediatric patients undergoing appendectomy at our institution.…”

New anthropometric classification scheme of preoperative nutritional status in children: a retrospective observational cohort study

“…Only a few studies in children undergoing non-cardiac surgery have sought an association between anthropometric classification and postoperative morbidity. Previous studies using the aggregate NSQIP paediatric dataset have shown that children in the ≤5th weight percentile experienced higher rates of postoperative transfusion and reintubation, 20 while children undergoing appendectomy 21 and urological procedures 22 who met BMI percentile definitions of overweight/obese were more likely to experience postoperative wound complications. However, a limitation of existing anthropometric classification schemes is that they were developed to define the nutritional state of an individual relative to a reference population of ‘healthy’ children.…”

Clinical, Laboratory and Radiographic Features Associated With Prolonged Hospitalization in Children With Complicated Appendicitis

“…Consistent with this, we observed a trend toward a longer duration of GI symptoms prior to admission in Black compared to Hispanic/Latino children (data not shown), which was one of the clinical features associated with LOS. Obesity has previously been associated with delay in diagnosis and increased risk of post-operative complications, including wound infection and dehiscence ( 20 – 22 ). In our study children with BMIs greater than the 85 th percentile had higher oxygen requirements and more episodes of sepsis; however, this did not result in overall longer LOS.…”