Background Posterior fossa decompression in the setting of Chiari malformation is a common neurosurgical procedure in adolescents; however, the effect of obesity on its surgical outcomes is understudied. This is partly due to the lower incidence of obesity in adolescents requiring higher statistical power. Correspondingly, we sought to interrogate a national surgical database to aggregate a significant cohort size to elucidate possible relationships between obesity and surgical outcomes in this niche. Methods The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric) database from 2015–2024 was interrogated against selection criteria targeting patients aged 10–18 years old surgically treated for Chiari malformation type 1. Adolescent weight was defined by body mass index into categories according to the definitions by Centers for Disease Control and Prevention (CDC). Thirty-day surgical outcomes were modeled using a multivariate logistic regression controlling for covariates across a primary model, and then across various sensitivity models. Results A total of 4257 patients satisfied selection criteria with a median age of 14.4 years, 65% female and 35% male. Median BMI was 22.7 kg/m2, and per CDC definitions 6% were underweight, 51% were healthy weight, 18% were overweight, and 28% were obese (Classes I, II and III). Overall, median length of stay was 3 days, and rates of 30-day reoperation (any), reoperation (related), unplanned readmission and major complications were 3.0%, 2.4%, 5.4%, and 3.5%, respectively. On analysis, categorical obesity (vs. healthy weight/underweight) was independently associated with the 30-day major complication composite (aOR 1.93, p < 0.001) and unplanned readmission (aOR 1.47, p = 0.012). Of the complications, surgical site infection (p < 0.001) and peripheral nerve injury (p = 0.011) were statistically more common in the obese group than others. As a continuous predictor, each + 1 SD increase in BMI-for-age z-score was independently associated with higher adjusted odds of 30-day major complication (aOR 1.25, p = 0.004) and unplanned readmission (aOR 1.13, p = 0.038). Finally, linear trend tests across all six CDC extended categories were significant for 30-day reoperation (any) (p = 0.031), reoperation (related) (p = 0.005), and unplanned readmission (p = 0.017). Conclusion In adolescents, there is a clear postoperative profile that exists 30-days after posterior fossa decompression for Chiari malformation based on weight and obesity. This profile is defined by increased morbidity rather than mortality, and future studies are needed to determine how these findings can be effectively integrated into preoperative evaluation and prehabilitation workup for patients to optimize surgical outcomes further.

Defining the associations between weight, obesity and outcomes of posterior fossa decompression for Chiari malformation in adolescents

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发表日期：

2026年7月24日

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Victor M. Lu,
Caleigh S. Roach,
Steven W. Hwang

摘要

Background

Posterior fossa decompression in the setting of Chiari malformation is a common neurosurgical procedure in adolescents; however, the effect of obesity on its surgical outcomes is understudied. This is partly due to the lower incidence of obesity in adolescents requiring higher statistical power. Correspondingly, we sought to interrogate a national surgical database to aggregate a significant cohort size to elucidate possible relationships between obesity and surgical outcomes in this niche.

Methods

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric) database from 2015–2024 was interrogated against selection criteria targeting patients aged 10–18 years old surgically treated for Chiari malformation type 1. Adolescent weight was defined by body mass index into categories according to the definitions by Centers for Disease Control and Prevention (CDC). Thirty-day surgical outcomes were modeled using a multivariate logistic regression controlling for covariates across a primary model, and then across various sensitivity models.

Results

A total of 4257 patients satisfied selection criteria with a median age of 14.4 years, 65% female and 35% male. Median BMI was 22.7 kg/m², and per CDC definitions 6% were underweight, 51% were healthy weight, 18% were overweight, and 28% were obese (Classes I, II and III). Overall, median length of stay was 3 days, and rates of 30-day reoperation (any), reoperation (related), unplanned readmission and major complications were 3.0%, 2.4%, 5.4%, and 3.5%, respectively. On analysis, categorical obesity (vs. healthy weight/underweight) was independently associated with the 30-day major complication composite (aOR 1.93, p < 0.001) and unplanned readmission (aOR 1.47, p = 0.012). Of the complications, surgical site infection (p < 0.001) and peripheral nerve injury (p = 0.011) were statistically more common in the obese group than others. As a continuous predictor, each + 1 SD increase in BMI-for-age z-score was independently associated with higher adjusted odds of 30-day major complication (aOR 1.25, p = 0.004) and unplanned readmission (aOR 1.13, p = 0.038). Finally, linear trend tests across all six CDC extended categories were significant for 30-day reoperation (any) (p = 0.031), reoperation (related) (p = 0.005), and unplanned readmission (p = 0.017).

Conclusion

In adolescents, there is a clear postoperative profile that exists 30-days after posterior fossa decompression for Chiari malformation based on weight and obesity. This profile is defined by increased morbidity rather than mortality, and future studies are needed to determine how these findings can be effectively integrated into preoperative evaluation and prehabilitation workup for patients to optimize surgical outcomes further.