ArticleAnnals of medicine2026
Association of body mass index with postoperative pulmonary complications and potential explanatory pathways in paediatric scoliosis correction surgery: a multicentre cohort study.
Article in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostoperative pulmonary complications (PPCs) contribute substantially to morbidity after paediatric scoliosis correction surgery, but the relationship between preoperative body mass index (BMI) and PPCs remains uncertain. We evaluated this association and explored potential explanatory pathways and the incremental predictive value of BMI.
methodsThis retrospective cohort study included 1,165 patients from three Chinese tertiary hospitals. Associations between BMI and the composite PPC outcome were evaluated using multivariable regression. An orthogonalized causal forest estimated the average partial effect of continuous BMI on PPC probability, and variation in model-derived partial-effect predictions across sex and preoperative Cobb-angle strata was examined descriptively. Exploratory pathway analyses considered the Prognostic Nutritional Index (PNI), intraoperative blood loss, and fusion levels. At the completion of surgery, the incremental predictive value of BMI was assessed using an elastic-net model developed in centres 1 and 3 and externally validated in centre 2.
resultsPPCs occurred in 321 patients (27.55%). In the primary preoperative-adjusted model, each 1-kg/m
conclusionsHigher preoperative BMI was associated with lower odds of PPCs, with a concordant inverse causal-forest estimate under its identification assumptions. Low BMI or thinness may serve as a preoperative risk marker, while the examined pathways accounted for only small proportions of the association. At the end-of-surgery prediction time point, adding BMI provided modest incremental predictive value, although the model's external performance was modest and further prospective validation is required.
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