Elsevier

Journal of Pediatric Surgery

Volume 50, Issue 11, November 2015, Pages 1880-1884
Journal of Pediatric Surgery

Original Article
The impact of obesity on laparoscopic appendectomy: Results from the ACS National Surgical Quality Improvement Program pediatric database

https://doi.org/10.1016/j.jpedsurg.2015.07.005Get rights and content

Abstract

Background

Childhood obesity is a worsening epidemic. Little is known about the impact of elevated BMI on perioperative and postoperative complications in children who undergo laparoscopic surgery. The purpose of this study was to examine the effects of obesity on surgical outcomes in children using laparoscopic appendectomy as a model for the broader field of laparoscopic surgery.

Study design

Using the Pediatric National Surgical Quality Improvement Program (NSQIP) data from 2012, patients aged 2–18 years old with acute uncomplicated and complicated appendicitis who underwent laparoscopic appendectomy were identified. Children with a body mass index (BMI)  95th percentile for their age and gender were considered obese. Primary outcomes, including overall morbidity and wound complications, were compared between nonobese and obese children. Multivariate regression analysis was conducted to identify the impact of obesity on outcome.

Results

A total of 2812 children with acute appendicitis who underwent appendectomy were included in the analysis; 22% were obese. Obese children had longer operative times but did not suffer increased postoperative complications when controlling for confounders (OR 1.3, 95% CI: 0.83–0.072 for overall complications, OR 1.3, 95% CI: 0.84–1.95 for wound complications).

Conclusions

Obesity is not an independent risk factor for postoperative complications following laparoscopic appendectomy. Although operative times are increased in obese children, obesity does not increase the likelihood of 30-day postoperative complications.

Section snippets

Data source and study population

The study was performed using data from the ACS NSQIP Pediatric Participant Use Data File (PUF) from 2012, with data from 50 participating institutions collected in the period from January 1st 2012 to December 31st 2012. The population consisted of patients aged 2 to 18 years who underwent laparoscopic appendectomy (LA) for acute appendicitis as their primary operative procedure (Current Procedural Terminology CPT code 44970). The diagnosis of complicated and uncomplicated appendicitis was

Study population and demographics

During the study period, a total of 5741 patients were registered in the NSQIP Pediatric PUF with a procedural code indicating appendectomy. Excluded from the analysis were 2929 patients with missing BMI data, outlier BMI, younger than 2 years of age, and cases performed in an elective setting (Fig. 1). The study population consisted of 2812 patients that met inclusion criteria. There were 2189 (77.8%) nonobese and 634 (22.5%) obese patients. Demographic characteristics and preoperative risk

Discussion

This analysis of a large multicenter pediatric dataset was performed to clarify the conflicting findings of past studies regarding the impact of obesity on postsurgical outcomes. Appendectomy is the most common general surgery operation in the pediatric population and was accordingly chosen as the focus of this investigation. In this study, we found that obesity is not a risk factor for postoperative complications in pediatric patients undergoing laparoscopic appendectomy. Although there was a

References (37)

  • G.R. Yannam et al.

    Single incision pediatric endosurgery (SIPES) appendectomy — is obesity a contraindication?

    J Pediatr Surg

    (2013)
  • N.E. Sharp et al.

    Accuracy of American College of Surgeons National Surgical Quality Improvement Program Pediatric for laparoscopic appendectomy at a single institution

    J Surg Res

    (2013)
  • C.L. Ogden et al.

    Prevalence of childhood and adult obesity in the United States, 2011–2012

    JAMA

    (2014)
  • A.S. Kelly et al.

    Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association

    Circulation

    (2013)
  • V. Calcaterra et al.

    Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity

    Clin Endocrinol (Oxf)

    (2008)
  • R. Weiss et al.

    Obesity and the metabolic syndrome in children and adolescents

    N Engl J Med

    (2004)
  • S.L. Doyle et al.

    Obesity and post-operative complications in patients undergoing non-bariatric surgery

    Obes Rev

    (2010)
  • O.A. Bamgbade et al.

    Postoperative complications in obese and nonobese patients

    World J Surg

    (2007)
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