Overweight and Obese Children Have Increased Likelihood of Developing Surgical Site Infections

Although obesity is a fairly well-known and accepted risk factor for surgical site infections (SSI) in adults, there has been relatively little research into how weight affects SSIs in pediatric populations. According to a recent study published in Surgical Infections, however, children who are overweight or obese also have a greater likelihood of developing SSIs. The research team noted that the study, which is the first of its kind, can be used by doctors to assess risk and counsel families regarding the risks and benefits of surgeries for overweight and obese patients.

The research team, led by Catherine Hunter, MD, an assistant professor of surgery at the Northwestern University Feinberg School of Medicine and a pediatric surgeon, reviewed data on 1,380 patients. These patients were between the ages of two and 18 years, and had undergone major surgical procedures during 2012 and 2013. The patients were reported to have developed post-operative wound infections up to 30 days after surgery. This pool was chosen out of a population of 66,671 patients in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P).

The researchers classified patients as underweight, normal, overweight, or obese based on body mass index (BMI). A total of 767 of the patients who developed SSIs were male, while 613 were female. “Of those, 29.6% were overweight or obese with few other identifiable SSI risk factors,” reported the authors, noting that appendectomies were the most common procedure associated with SSIs. Patients undergoing pediatric general surgery and cardiothoracic surgery had the highest rates of SSI development with 3.6% and 2.5%, respectively. The research team also evaluated comorbidities associated with SSIs, including operative wound classification, diabetes mellitus, immunosuppression, history of transfusion, and steroid use.

The researchers found that 136 patients in the study developed an SSI immediately after surgery. By gender, 79 were male and 57 were female, with an average age of 9.2 years. In addition, 30% (41) had an abnormal BMI (underweight, overweight, or obese), but had no other identifiable SSI risk factors. The research team noted that seven of the 41 patients did not receive prophylactic antibiotics within one hour of incision time, and that none of the patients were diabetic, immunosuppressed, had a history of transfusion, or a history of steroid-use. “The majority of these patients (32) had a wound classification of I or II,” they added, meaning that, at the conclusion of surgery, the surgical wound was determined to be either clean (classification I), defined as uninfected with no inflammation and closed primarily, or clean-contaminated (classification II), defined as no unusual contamination despite controlled entry of respiratory, GI, or GU tracts. The research team concluded, “SSIs are significant complications that affect all surgical specialties,” and added, “[This research] indicates an abnormal BMI is an independent risk factor for developing an SSI.”

The Centers for Disease Control and Prevention (CDC) warns that obese children are at higher risk for other health issues in addition to those associated with surgery. These include “high cholesterol, high blood pressure, and abnormal glucose tolerance.” Children may also develop health conditions such as asthma, hepatitis steatosis, sleep apnea, and type 2 diabetes. In order to assist children in achieving and maintaining healthy weight, it’s important to “help children avoid too much sedentary time in addition to encouraging physical activity.” Furthermore, the CDC reports that avoiding sugar-sweetened drinks and providing plenty of healthy eating options like vegetables, fruits, lean meats, and whole-grain products will help children develop healthy eating habits.