Childhood Obesity as a Risk Factor for Postoperative Complications: A Review

Abstract

Background. Childhood obesity is an increasingly common challenge in pediatric surgery and may increase perioperative and postoperative risk because of physiological and metabolic alterations. The clinical impact depends on age, obesity severity, associated comorbidities, and the type of surgical procedure. Aim. To review current evidence on the relationship between childhood obesity and postoperative complications and summarize practical strategies for perioperative risk assessment and management in pediatric surgical patients. Material and methods. A narrative review of peer-reviewed studies evaluating postoperative outcomes in obese children undergoing surgery was conducted. Evidence on respiratory complications, wound healing, surgical-site infections, thromboembolic events, operative characteristics, and perioperative management was analyzed. Results. Childhood obesity is associated with an increased risk of perioperative respiratory complications, difficult airway management, surgical-site infections, wound complications, and longer operative time. However, obesity alone is not a consistent predictor of adverse outcomes, as risk is also influenced by obesity severity, comorbidities, surgical complexity, and perioperative care. Individualized perioperative management, including BMI assessment, screening for sleep-disordered breathing, optimized drug dosing, lung-protective ventilation, weight-adjusted antimicrobial prophylaxis, multimodal analgesia, and early mobilization, may reduce complications. Conclusions. Childhood obesity should be regarded as an important modifier of perioperative risk rather than an independent predictor of postoperative complications. Multidisciplinary assessment and individualized perioperative management are essential to optimize outcomes. Further prospective studies using standardized pediatric outcome measures are needed.