Overweight and Obese Pediatric Patients Have an Increased Risk of Developing a Surgical Site Infection.

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.