title: The importance of extreme weight percentile in postoperative morbidity in children.
abstract: BACKGROUND
  Anthropometric data are important indicators of child health. This study sought to determine whether anthropometric data of extreme weight were significant predictors of perioperative morbidity in pediatric surgery.
  
  
  METHODS
  This was a cohort study of children 29 days up to 18 years of age undergoing surgical procedures at participating American College of Surgeons' NSQIP Pediatric hospitals in 2011 and 2012. The primary outcomes were composite morbidity and surgical site infection. The primary predictor of interest was weight percentile, which was divided into the following categories: ≤5(th) percentile, 6(th) to 94(th), or ≥95(th) percentile. A hierarchical multivariate logistic model, adjusting for procedure case mix, demographic, and clinical patient characteristic variables, was used to quantify the relationship between weight percentile category and outcomes.
  
  
  RESULTS
  Children in the ≤5th weight percentile had 1.19-fold higher odds of overall postoperative morbidity developing than children in the nonextreme range (95% CI, 1.10-1.30) when controlling for clinical variables. Yet these children did not have higher odds of surgical site infection developing. Children in the ≥95(th) weight percentile did not have a significant increase in overall postoperative morbidity. However, they were at 1.35-fold increased odds of surgical site infection compared with those in the nonextreme range when controlling for clinical variables (95% CI, 1.16-1.57).
  
  
  CONCLUSIONS
  Both extremely high and extremely low weight percentile scores can be associated with increased postoperative complications after controlling for clinical variables.
authors.affiliation: Department of Surgery, Mount Sinai Medical Center, New York, NY; Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA. Electronic address: as013j@gmail.com.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stey
authors.affiliation: Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors.forename: Kari
authors.initials: K
authors.lastname: Kraemer
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in Saint Louis, St Louis, MO; Olin Business School, St Louis, MO; Center for Health Policy, St Louis VA Medical Center, St Louis, MO; BJC Healthcare Saint Louis, St Louis, MO.
authors.forename: Bruce
authors.initials: B
authors.lastname: Lee Hall
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity / Q000639:trends; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology