MON-697 - Association of Body Mass Index Z-Score with Postoperative Complications in Children Undergoing Brain Tumor Excision: A National Retrospective Study

Introduction

Children undergoing brain tumor excision are a medically complex surgical population. Although elevated BMI has been associated with adverse outcomes across multiple pediatric surgical procedures, its impact across the full BMI z-score spectrum on postoperative outcomes in pediatric neurosurgery is poorly defined. We evaluated the association between BMI z-score and 30-day postoperative complications in children undergoing brain tumor excision using a national surgical registry, hypothesizing that underweight and obesity would be associated with increased postoperative morbidity.

Methods

We performed a retrospective cohort study of children undergoing supratentorial or infratentorial/posterior fossa brain tumor excision using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric) database (2012-2023). Age- and sex-adjusted BMI z-scores were calculated and categorized as underweight, normal weight, overweight, or obese. Outcomes included any 30-day postoperative complication (major or minor) and unplanned readmission. Multivariable logistic regression adjusted for demographic and clinical covariates, and analyses were stratified by CPT code to account for differences in surgical complexity.

Results

The cohort included 9,794 children (55.2% male) with a mean age of 10.9 ± 4.6 years. Based on BMI z-score, 628 (6.4%) were underweight, 5,441 (55.6%) were normal weight, 1,592 (16.3%) were overweight, and 2,132 (21.8%) were obese.

In multivariable analyses, underweight status was associated with higher odds of any postoperative complication (OR 1.38; 95% CI, 1.06-1.79), minor complications (OR 1.75; 95% CI, 1.23-2.49), and unplanned readmission (OR 1.28; 95% CI, 1.01-1.61), compared with normal-weight patients. Overweight and obese status were not associated with increased odds of postoperative complications.

In procedure-specific analyses, among patients undergoing supratentorial tumor excision underweight status was associated with increased odds of unplanned readmission (OR 1.78; 95% CI, 1.28-2.44; p < 0.001). Among patients undergoing infratentorial or posterior fossa tumor excision (CPT 61518), underweight status was associated with increased odds of any

postoperative complication (OR 1.45; 95% CI, 1.03-2.02; p = 0.031) and minor complications (OR 1.87; 95% CI, 1.23-2.84; p = 0.003), while obese status was also associated with increased odds of minor complications (OR 1.53; 95% CI, 1.09-2.14; p = 0.014).

Conclusion

In children undergoing brain tumor excision, underweight status is independently associated with increased postoperative morbidity and unplanned readmission. These findings demonstrate the importance of perioperative nutritional assessment and optimization and suggest that BMI can inform surgical risk stratification.

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