Impact of body mass index on 30-day postoperative morbidity in pediatric and adolescent patients undergoing continent urinary tract reconstruction.

Summary Introduction Obesity has been thought to increase the risk of complications and need for additional resources with surgery, but only a limited amount of evidence is available in the pediatric population. Objective The objectives were to describe the weight status of pediatric and adolescent patients undergoing a continent urinary tract reconstruction and to determine the association between obesity and 30-day postoperative morbidity. Study design A retrospective cohort study was performed for pediatric and adolescent patients aged up to 20 years who underwent a continent urinary tract reconstruction between January 2010 and November 2016. Weight status was stratified by the body mass index (BMI) for age z-scores as follows: underweight ( Results A total of 182 continent reconstructions were identified during the study period. Demographic and peri-operative data are provided in the Table. Weight status was not associated with any primary outcomes on univariate or multivariate analysis. There was also no association in an analysis between the non-overweight or non-obese group (BMI for age z-score Discussion Obesity has been consistently associated with an increased risk of surgical site infections and wound complications after a wide variety of surgeries in adults. The results from the present study conflict with those of the few available studies in the pediatric population. The high-risk nature of the present cohort may have mitigated any effect of obesity on 30-day postoperative morbidity. The limitations of the present study include its retrospective design at a single center and the potential misclassification of weight status with the BMI. Conclusions Almost 30% of pediatric and adolescent patients undergoing a continent urinary tract reconstruction were overweight or obese. Obesity as determined by the BMI was not associated with 30-day postoperative morbidity. Table 1Demographic and peri-operative data. Age at surgery in years, median (IQR) 8.1 (5.9–11.4) Gender, n (%) Male 90 (49.5) Female 92 (50.5) Primary diagnosis, n (%) Myelomeningocele 66 (36.3) Anorectal malformation 61 (33.5) Bladder or cloacal exstrophy 15 (8.2) Other 40 (22.0) Ambulatory with or without aids, n (%) 148 (81.3) Body mass index (BMI) in kg/m2, median (IQR) 18.3 (15.0–20.4) Weight status, n (%) Underweight ( 16 (8.8) Normal (5th to 114 (62.6) Overweight (85th to 24 (13.2) Obese (≥95th percentile) 28 (15.4) Any level of obesity (BMI for age z-score ≥85th percentiles), n (%) 52 (28.6) ASA classification, median (IQR) 3.0 (3.0–3.0) Chronic kidney disease, n (%) 38 (20.9) Re-operative with prior abdominal surgery, n (%) 124 (86.1) Bladder neck procedure, n (%) 87 (47.8) Augmentation cystoplasty, n (%) 74 (40.7) Urinary continent catheterizable channel or subfascial revision, n (%) 170 (93.4) Procedure for anterograde continence enema, n (%) 114 (62.6) Bowel anastomosis, n (%) 107 (58.8) Estimated blood loss in mL, median (IQR) 60.0 (20.0–150.0) Operative time in minutes, median (IQR) 529.0 (394.0–630.0) Duration of intensive care in days, median (IQR) 1.0 (0.0–2.0) Duration of hospitalization in days, median (IQR) 11.0 (8.0–13.0) 30-day re-admissions, n (%) 26 (14.3) 30-day complications, n (%) Overall 76 (41.8) Infectious 42 (23.1) Wound 21 (11.5) High-grade 22 (12.1)