title: Overweight and Obese Pediatric Patients Have an Increased Risk of Developing a Surgical Site Infection.
abstract: BACKGROUND
  Obesity is a known risk factor in adult surgical site infections (SSIs), but its significance in pediatrics is unclear. We hypothesized that overweight and obese children have increased risk for SSI.
  
  
  METHODS
  A National Surgical Quality Improvement Program-Pediatric (NSQIP-P) file and single-center reviews identified surgical patients (2-18 years) who developed SSIs. Patients were classified as underweight, normal, overweight, or obese based on body mass index (BMI). Comorbidities associated with SSI were analyzed. Sub-specialties and operations were recorded.
  
  
  RESULTS
  National Surgical Quality Improvement Program-Pediatric review identified 66,671 patients and 1,380 SSIs. Seven hundred sixty-seven (767) were male and 613 female. Multivariable analysis revealed overweight and obese BMI to be risk factors for SSIs (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.06-1.43; OR 1.43, 95% CI 1.25-1.63). Most commonly, overweight and obese cohorts had superficial incisional SSIs. Pediatric general surgery (3.6%) and cardiothoracic surgery (2.5%) had the highest rates of SSIs. Single-center review identified 115 SSIs. Of these, 29.6% were overweight or obese with few other identifiable SSI risk factors. Sub-specialties with the most SSIs were pediatric surgery and pediatric orthopedics. Appendectomy was the most common procedure associated with SSIs.
  
  
  CONCLUSIONS
  Herein we show elevated BMI to be a significant risk factor for SSIs. This information should be used in assessing and counseling pre-operative pediatric patients and families.
authors.affiliation: 1 Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.|3 Department of General Surgery, Rush University Medical Center , Chicago, Illinois.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Blackwood
authors.affiliation: 1 Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Gause
authors.affiliation: 3 Department of General Surgery, Rush University Medical Center , Chicago, Illinois.
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Harris
authors.affiliation: 2 Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Theodorou
authors.affiliation: 4 Department of Preventative Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Irene
authors.initials: I
authors.lastname: Helenowski
authors.affiliation: 1 Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Lautz
authors.affiliation: 1 Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.
authors.forename: Julia
authors.initials: J
authors.lastname: Grabowski
authors.affiliation: 1 Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.|2 Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Hunter
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: body mass index; obesity; overweight; risk factor; surgical site infection