Association of nutritional risk factors with adverse outcomes after pediatric otolaryngology surgery: Analysis of the NSQIP-P database.

OBJECTIVE: To evaluate the association between nutritional status and postoperative outcomes in pediatric otolaryngology, and to compare the relative utility of underweight BMI and nutritional support as markers of perioperative risk. STUDY DESIGN: Retrospective cohort study. SETTING: American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P), 2015-2023. METHODS: Pediatric patients undergoing otolaryngologic surgery were identified. Underweight status was defined as BMI-for-age below the 5th percentile, and nutritional support was defined as receipt of enteral or parenteral nutrition at the time of surgery. Multivariable logistic regression and propensity score matching with doubly robust analysis were used to evaluate associations between nutritional factors and 30-day postoperative outcomes. RESULTS: A total of 58,723 patients were included, of whom 4690 (8.0%) were underweight. On unadjusted analysis, underweight patients had higher rates of cardiopulmonary complications (3.4% vs 1.2%, p < 0.001), wound infection (2.3% vs 1.8%, p = 0.015), readmission (3.8% vs 2.6%, p < 0.001), and reoperation (2.7% vs 1.7%, p < 0.001). After adjustment, underweight BMI was not independently associated with postoperative outcomes. In propensity-matched analyses, underweight BMI remained associated only with cardiopulmonary complications (OR 1.25, 95% CI 1.04-1.50, p = 0.015). In contrast, nutritional support was consistently associated with cardiopulmonary complications (OR 2.02, 95% CI 1.62-2.51), readmission (OR 1.61, 95% CI 1.34-1.94), and reoperation (OR 1.54, 95% CI 1.22-1.94) (all p < 0.001). No interaction was observed between BMI and nutritional support. CONCLUSION: Underweight BMI is not consistently associated with postoperative complications, whereas nutritional support is a robust marker of increased perioperative risk.