Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children

  • Leanne ThaljiEmail author
  • Yu Shi
  • Kristine T. Hanson
  • Elliot Wakeam
  • Elizabeth B. Habermann
  • Joseph A. Hyder
Original Article



While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs).


In this retrospective cohort study, we evaluated pediatric patients (aged 2–17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class—using the Centers for Disease Control age- and sex-dependent BMI percentiles—and severe PPCs.


Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07–3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53–1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63–1.94), p = 0.73] were associated with PPCs after adjustment.


Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from “availability bias”. Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.


Pediatric surgery BMI Respiratory complications 



The work was performed without extramural funding, support was provided solely from institutional and/or departmental sources.

Compliance with ethical standards

Conflict of interest

The authors report no potential financial, commercial or ethical conflicts of interest regarding the contents of this manuscript.

Supplementary material

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Supplementary file1 (DOCX 26 kb)
540_2019_2639_MOESM2_ESM.docx (20 kb)
Supplementary file2 (DOCX 19 kb)


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Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  • Leanne Thalji
    • 1
    Email author
  • Yu Shi
    • 1
  • Kristine T. Hanson
    • 2
  • Elliot Wakeam
    • 3
  • Elizabeth B. Habermann
    • 2
  • Joseph A. Hyder
    • 1
    • 2
    • 4
  1. 1.Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterUSA
  2. 2.Robert D and Patricia E Kern Center for the Science of Health Care DeliveryRochesterUSA
  3. 3.Department of SurgeryUniversity of TorontoTorontoCanada
  4. 4.Division of Critical Care MedicineMayo ClinicRochesterUSA

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