Overweight and obese children are at the highest risk for the most common complications from surgery, an infection at the site of the surgical procedure. This according to a new study, recently published in the medical journal, Surgical Infections.
While obesity is a well-known risk factor for surgical site infections (SSI) among adult patients, this is the first research showing it is equally significant in pediatric populations. And since the incidence of childhood obesity in the US has nearly tripled since the 1970s, this indicates more and more children will possibly be at risk for these infections.
"Research on this topic among children and adolescents is scarce," said Catherine Hunter, MD, Pediatric Surgeon at Ann & Robert H. Lurie Children's Hospital of Chicago and an Assistant Professor of Surgery and Pediatrics, Northwestern University Feinberg School of Medicine. (https://www.luriechildrens.org/en-us/care-services/find-a-doctor/Pages/Hunter_Catherine_3205.aspx) "The information from this first-of-its-kind study can now be used in assessing and counseling preoperative pediatric surgical patients and their families."
The study, titled "Overweight and Obese Pediatric Patients Have an Increased Risk of Developing a Surgical Site Infection," included a search of the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database, as well as a follow-up single center retrospective review. The latter review allowed for a more detailed analysis using specific outcomes variables that could not be analyzed using the NSQIP-P database, including looking at those overweight and obese pediatric patients who developed SSI despite having few other identifiable risk factors for infection.
Cases from a total of 1,380 patients aged 2-18 (mean patient age 10.4 years) from the NSQIP-P database who had undergone major surgical procedures in 2012 and 2013 and who developed post-operative wound infections up to 30 days after surgery were reviewed. Patients were classified as underweight, normal/healthy weight, overweight, or obese, according to standard CDC pediatric growth charts, with a 95% confidence interval.
Forty-percent of these patients who had SSIs were overweight or obese and without differences in gender.
In the single site retrospective review, data from another 115 patients were considered. Of this population the average age was slightly younger at 9 years and 30% were overweight or obese.
"When considering children, adolescents and adults, there are several theories as to why overweight or obese patients are at higher risk for infection," said Dr. Hunter. "These include impaired wound healing due to the lower oxygen tension found in the excess fat tissue surrounding the wound as well as impaired lymphocyte responsiveness. However more studies need to look at this further."
Ann & Robert H. Lurie Children's Hospital of Chicago