Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children

Leanne Thalji, Yu Shi, Kristine T. Hanson, Elliot Wakeam, Elizabeth B Habermann, Joseph A. Hyder

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). Methods: In this retrospective cohort study, we evaluated pediatric patients (aged 2–17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class—using the Centers for Disease Control age- and sex-dependent BMI percentiles—and severe PPCs. Results: Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07–3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53–1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63–1.94), p = 0.73] were associated with PPCs after adjustment. Conclusion: Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from “availability bias”. Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.

Original languageEnglish (US)
Pages (from-to)372-380
Number of pages9
JournalJournal of Anesthesia
Volume33
Issue number3
DOIs
StatePublished - Jun 20 2019

Fingerprint

Body Mass Index
Lung
Pediatrics
Thinness
Pneumonia
Obesity
Perioperative Care
Diagnosis-Related Groups
Centers for Disease Control and Prevention (U.S.)
Quality Improvement
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Weights and Measures

Keywords

  • BMI
  • Pediatric surgery
  • Respiratory complications

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children. / Thalji, Leanne; Shi, Yu; Hanson, Kristine T.; Wakeam, Elliot; Habermann, Elizabeth B; Hyder, Joseph A.

In: Journal of Anesthesia, Vol. 33, No. 3, 20.06.2019, p. 372-380.

Research output: Contribution to journalArticle

Thalji, Leanne ; Shi, Yu ; Hanson, Kristine T. ; Wakeam, Elliot ; Habermann, Elizabeth B ; Hyder, Joseph A. / Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children. In: Journal of Anesthesia. 2019 ; Vol. 33, No. 3. pp. 372-380.
@article{36cb83ca5b56463d8b7cf7dc30c0a9d6,
title = "Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children",
abstract = "Purpose: While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). Methods: In this retrospective cohort study, we evaluated pediatric patients (aged 2–17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class—using the Centers for Disease Control age- and sex-dependent BMI percentiles—and severe PPCs. Results: Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7{\%}) were underweight, 23,630 (57.7{\%}) normal weight, 6161 (15.0{\%}) overweight, and 8418 (20.6{\%}) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95{\%} CI 1.07–3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95{\%} CI 0.53–1.94), p = 0.97] nor obesity [OR 1.10 (95{\%} CI 0.63–1.94), p = 0.73] were associated with PPCs after adjustment. Conclusion: Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from “availability bias”. Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.",
keywords = "BMI, Pediatric surgery, Respiratory complications",
author = "Leanne Thalji and Yu Shi and Hanson, {Kristine T.} and Elliot Wakeam and Habermann, {Elizabeth B} and Hyder, {Joseph A.}",
year = "2019",
month = "6",
day = "20",
doi = "10.1007/s00540-019-02639-z",
language = "English (US)",
volume = "33",
pages = "372--380",
journal = "Journal of Anesthesia",
issn = "0913-8668",
publisher = "Springer Japan",
number = "3",

}

TY - JOUR

T1 - Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children

AU - Thalji, Leanne

AU - Shi, Yu

AU - Hanson, Kristine T.

AU - Wakeam, Elliot

AU - Habermann, Elizabeth B

AU - Hyder, Joseph A.

PY - 2019/6/20

Y1 - 2019/6/20

N2 - Purpose: While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). Methods: In this retrospective cohort study, we evaluated pediatric patients (aged 2–17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class—using the Centers for Disease Control age- and sex-dependent BMI percentiles—and severe PPCs. Results: Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07–3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53–1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63–1.94), p = 0.73] were associated with PPCs after adjustment. Conclusion: Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from “availability bias”. Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.

AB - Purpose: While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). Methods: In this retrospective cohort study, we evaluated pediatric patients (aged 2–17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class—using the Centers for Disease Control age- and sex-dependent BMI percentiles—and severe PPCs. Results: Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07–3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53–1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63–1.94), p = 0.73] were associated with PPCs after adjustment. Conclusion: Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from “availability bias”. Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.

KW - BMI

KW - Pediatric surgery

KW - Respiratory complications

UR - http://www.scopus.com/inward/record.url?scp=85066837905&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066837905&partnerID=8YFLogxK

U2 - 10.1007/s00540-019-02639-z

DO - 10.1007/s00540-019-02639-z

M3 - Article

C2 - 30976907

AN - SCOPUS:85066837905

VL - 33

SP - 372

EP - 380

JO - Journal of Anesthesia

JF - Journal of Anesthesia

SN - 0913-8668

IS - 3

ER -