title: Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes.
abstract: OBJECTIVE
  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 ≥2 to <18years 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=9606) and those undergoing all other intestinal operations (n=2664) 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 multivariate 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.
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, USA, 98195; Harborview Injury Prevention and Research Center, 325 9th Ave, Box 359960, Seattle, WA, USA, 98104. Electronic address: cwitt@u.washington.edu.
authors.forename: Cordelie E
authors.initials: CE
authors.lastname: Witt
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, USA, 98105. Electronic address: adam.goldin@seattlechildrens.org.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, USA, 98195; Harborview Injury Prevention and Research Center, 325 9th Ave, Box 359960, Seattle, WA, USA, 98104. Electronic address: vavilala@u.washington.edu.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.affiliation: Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA, USA, 98195; Harborview Injury Prevention and Research Center, 325 9th Ave, Box 359960, Seattle, WA, USA, 98104. Electronic address: fpr@u.washington.edu.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D063766:Pediatric Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors
keywords: Appendicitis; Gastrointestinal surgery; Obesity; Pediatric