Obesity and Postoperative Complications in Pediatric Adolescent Idiopathic Scoliosis Surgery: A Decade-Long Analysis (2009-2020)

Introduction: Over the past decade, pediatric obesity has been a growing concern, with a prevalence rate of 19.7% as of 2020. Obesity increases the likelihood of greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Understanding the correlation between obesity and postoperative outcomes following scoliosis surgery can improve preoperative counseling and patient optimization.

Methods: Using the National Inpatient Sample (NIS) from 2009 to 2020, pediatric patients diagnosed with AIS and treated with posterior spinal fusion involving more than eight levels were identified. Patients were stratified based on obesity status, and a multivariable logistic regression was used to control for confounders. A stepwise backward elimination model was applied, and model fit was assessed using the area under the curve.

Results: A total of 10,200 obese and 18,100 non-obese pediatric patients were identified during the study period. The obese group had significantly higher rates of SSI (1.0% vs. 0.3%, p< 0.001), UTI (1.4% vs. 0.4%, p< 0.001), and acute kidney injury (AKI) (0.8% vs. 0.2%, p=0.11). Obese patients were more likely to experience a non-routine discharge (5.2% vs. 2.5%, p< 0.001) and had a higher but non-significant likelihood of multiple postoperative complications (1.0% vs. 0.6%, p=0.08). On multivariate regression analysis, obesity was independently associated with increased odds of SSI (OR=3.0, CI=1.2-7.8, p=0.04), UTI (OR=2.5, CI=1.2-4.8, p=0.02), non-routine discharge (OR=1.8, CI=1.3-2.4, p=0.01), and extended LOS (OR=2.0, CI=1.7-2.4, p< 0.001).

Conclusion : Obesity in pediatric patients undergoing posterior spinal fusion for AIS is associated with increased rates of postoperative complications such as SSI, UTI, extended hospital stays, and non-routine discharges. These findings underscore the importance of preoperative risk stratification and BMI optimization to reduce morbidity and healthcare costs in this vulnerable population.