Obesity Increases Risk for Surgical Site Infections and Wound Dehiscence after Pediatric Foot Surgery: A Retrospective Cohort Review using the NSQIP-Pediatric Database

CATEGORY: Other INTRODUCTION/PURPOSE: Both the incidence of childhood obesity and the number of obese children undergoing surgical procedures are increasing in pediatrics. As such, pediatric orthopaedic surgeons will likely encounter obese patients more frequently in their practice and a better understanding of the unique risks associated with obesity is valuable to maximize patient safety. The purpose of this study is, therefore, to retrospectively evaluate the relationship between obesity and post-operative outcomes in pediatric orthopaedic surgery patients across multiple institutions using a large national database. METHODS: Pediatric patients who had undergone foot surgery were retrospectively identified by cross-referencing reconstructive foot-specific CPT codes with ICD-9/ICD-10 diagnosis codes using the American College of Surgeons 2012-2017 Pediatric National Surgical Quality Improvement (ACS-NSQIP-Pediatric) database. Patients were stratified into normal weight and obese cohorts based upon Center for Disease Control BMI-to-age growth charts. Patient demographics, comorbidities, intra-operative, and post- operative factors were compared between these two cohorts via univariate analysis with false discovery rate adjustment. Multivariable logistic regression models were then generated to assess for obesity as an independent predictor of post-operative complications. RESULTS: Of the 3,924 patients identified, 1,063 (27.1%) were obese. Obese patients were more often male (64.7% vs 58.7%; p=0.001) and taller (56.3in vs 51.3in; p<0.001) than normal weight patients. There were no differences in pre-operative comorbidities between the two cohorts. Obese patients had a higher overall post-operative complication rate compared to normal weight patients (3.01% vs 1.32%; p=0.001). There was a significantly higher rate of wound dehiscence in obese patients (1.41% vs 0.59%; p=0.039) as well as a higher surgical site infection (SSI) rate that trended towards, but did not reach, statistical significance (1.32% vs. 0.59%; p=0.061). No differences were noted in unplanned readmissions (1.03% vs 0.9%; p=0.968) or unplanned reoperations (1.03% vs. 0.45%; p=0.175) within 30 days of surgery between the two groups. In multivariate analysis, obesity was found to be an independent predictor of both wound dehiscence (adjusted OR=2.16; 95%CI=1.05-4.50; p=0.037) and SSI (adjusted OR=3.03; 95%CI=1.39-6.61; p=0.005). CONCLUSION: Obese children undergoing foot surgery had higher overall complication rates than normal weight patients. Obese children undergoing foot surgery may be at higher risk for wound complications and surgical site infections than those of normal weight. This information may be useful in assessing and discussing surgical risks with patients and their families.