BACKGROUND: Malnutrition is a significant concern in the hospitalized surgical cohort. Despite this there is no standardized scheme tailored for the pediatric surgical cohort. This study evaluated the feasibility to of the novel two-axis scheme to fill the lacunae in pediatric nutritional assessment. AIMS: The aim of this study is to study the effect of the preoperative nutritional status on the clinical outcomes. MATERIALS AND METHODS: This is a prospective, observational, and cohort study of all pediatric patients undergoing surgery at our center from January 2021 to September 2022. Preoperative anthropometry was measured and all subjects were classified using the two-axis scheme incorporating body mass index and height RESULTS: The study included a total of 827 patients who underwent 1022 surgeries, 70.5% being males. About 33% of the cohort was under 5 years of age. Overall incidence of complications was 10.1% with underweight short group having the highest (19.7%). Underweight short group had higher incidence of composite and healthcare-associated infections ( CONCLUSIONS: This study supported the predictive value and feasibility of this novel two-axis nutritional classification scheme in the pediatric surgical outcomes. The underweight short subjects are at higher risk of developing postoperative complications.