Download PDF
CC BY 4.0 · Surg J (N Y) 2024; 10(04): e37-e42
DOI: 10.1055/s-0044-1791968
Original Article

Pediatric Obesity's Effect on Open and Laparoscopic Appendectomy Outcomes

Anshul Bhatnagar
1   School of Medicine, Baylor College of Medicine, Houston, Texas
,
Nishtha Nigam
2   Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ
,
Rohan Anne
3   Department of Neuroscience, Lawrence University, Appleton, Wisconsin
,
Sadashiv Santosh
4   Ascension Columbia St. Mary's Hospital, Mequon, Wisconsin
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Pediatric obesity is a common comorbid condition that may complicate pediatric surgeries, such as appendectomy. Prior research on the consequences of obesity on pediatric appendectomy outcomes have been limited by small-sample sizes and pooled analyses that do not distinguish the effects of surgical approach. Associations between surgical approach, pediatric obesity, and postoperative appendectomy outcomes thus remain unclear.

Objective To analyze postoperative appendectomy outcomes by accounting for pediatric obesity, appendectomy approach, and their interaction. This is a retrospective cohort population analysis. Nationwide data of pediatric inpatients from the United States were obtained. All pediatric patients who had an appendectomy were selected from the 2019 Kids' Inpatient Database.

Materials and Methods Outcomes variables were the length of stay and postoperative complication rate. The primary exposure variables were pediatric obesity, surgical approach (laparoscopic [LA] vs. open appendectomy [OA]), and an interaction term between the two. Control variables were patient demographics, clinical complexity, and geographic location. Multiple regression was used to determine relationships between the outcome, exposure, and control variables.

Results A total of 49,037 pediatric patients had an appendectomy, with the number of OA and LA being 4,517 and 44,420, respectively. LA patients had 5.8% (p < 0.001) shorter length of stay than OA patients. For obese patients, length of stay was 31.8% (p < 0.001) longer than for nonobese patients, but LA (compared with OA) reduced it by 19% (p < 0.007). Obesity had no effect on the number of postoperative complications.

Conclusion Obese patients had significantly longer length of stay than nonobese counterparts following OA (31.8%), but this difference was minimized for LA patients (15.81%). There was no association between complication rate, obesity, and surgical approach. Our findings will enable more accurate estimations of pediatric patients' postoperative courses and efficient allocation of limited hospital resources. Further research may wish to study the effects of other common pediatric comorbidities on other procedures.

Keywords

laparoscopic appendectomy - open appendectomy - obesity - length of stay - postoperative complications - regression


Publication History

Received: 26 July 2023

Accepted: 23 September 2024

Article published online:
24 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jones MW, Lopez RA, Deppen JG. Appendicitis. StatPearls Publishing; 2024. . Accessed February 3, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK493193/
    Search in Google Scholar
  • 2 Teng TZJ, Thong XR, Lau KY, Balasubramaniam S, Shelat VG. Acute appendicitis-advances and controversies. World J Gastrointest Surg 2021; 13 (11) 1293-1314
    CrossrefPubMedSearch in Google Scholar
  • 3 Bailey K, Choynowski M, Kabir SMU, Lawler J, Badrin A, Sugrue M. Meta-analysis of unplanned readmission to hospital post-appendectomy: an opportunity for a new benchmark. ANZ J Surg 2019; 89 (11) 1386-1391
    CrossrefPubMedSearch in Google Scholar
  • 4 Li X, Zhang J, Sang L. et al. Laparoscopic versus conventional appendectomy–a meta-analysis of randomized controlled trials. BMC Gastroenterol 2010; 10 (01) 129
    CrossrefPubMedSearch in Google Scholar
  • 5 Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics 2018; 141 (03) e20173459
    CrossrefPubMedSearch in Google Scholar
  • 6 Ruiz LD, Zuelch ML, Dimitratos SM, Scherr RE. Adolescent obesity: diet quality, psychosocial health, and cardiometabolic risk factors. Nutrients 2019; 12 (01) 43
    CrossrefPubMedSearch in Google Scholar
  • 7 Delgado-Miguel C, Muñoz-Serrano AJ, Barrena Delfa S. et al. Influence of overweight and obesity on acute appendicitis in children. A cohort study. Cir Pediáatr 2020; 33 (01) 20-24
    PubMedSearch in Google Scholar
  • 8 Lorio E, Ballard DH, Guarisco E, Hughes J, Griffen FD, Samra NS. Appendectomy hospital stay: no difference in obese adult or pediatric patient length of stay compared to nonobese patients. Ochsner J 2021; 21 (01) 14-18
    CrossrefPubMedSearch in Google Scholar
  • 9 Blanco FC, Sandler AD, Nadler EP. Increased incidence of perforated appendicitis in children with obesity. Clin Pediatr (Phila) 2012; 51 (10) 928-932
    CrossrefPubMedSearch in Google Scholar
  • 10 Namba Y, Hirata Y, Mukai S. et al. Clinical indicators for the incidence of postoperative ileus after elective surgery for colorectal cancer. BMC Surg 2021; 21 (01) 80
    CrossrefPubMedSearch in Google Scholar
  • 11 Danwang C, Bigna JJ, Tochie JN. et al. Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis. BMJ Open 2020; 10 (02) e034266
    CrossrefPubMedSearch in Google Scholar
  • 12 Zamaray B, de Boer MFJ, Popal Z, Rijbroek A, Bloemers FW, Oosterling SJ. AbcApp: incidence of intra-abdominal ABsCesses following laparoscopic vs. open APPendectomy in complicated appendicitis. Surg Endosc 2023; 37 (03) 1694-1699
    CrossrefPubMedSearch in Google Scholar
  • 13 Okabayashi K, Ashrafian H, Zacharakis E. et al. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today 2014; 44 (03) 405-420
    CrossrefPubMedSearch in Google Scholar
  • 14 Ingram ME, Calabro K, Polites S. et al. Systematic review of disparities in care and outcomes in pediatric appendectomy. J Surg Res 2020; 249: 42-49
    CrossrefPubMedSearch in Google Scholar
  • 15 Siddique SM, Tipton K, Leas B. et al. Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open 2021; 4 (09) e2125846
    CrossrefPubMedSearch in Google Scholar
  • 16 Pogorelić Z, Domjanović J, Jukić M, Poklepović Peričić T. Acute appendicitis in children younger than five years of age: diagnostic challenge for pediatric surgeons. Surg Infect (Larchmt) 2020; 21 (03) 239-245
    CrossrefPubMedSearch in Google Scholar
  • 17 Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr 2017; 43 (01) 15
    CrossrefPubMedSearch in Google Scholar
  • 18 Baxter KJ, Nguyen HTMH, Wulkan ML, Raval MV. Association of health care utilization with rates of perforated appendicitis in children 18 years or younger. JAMA Surg 2018; 153 (06) 544-550
    CrossrefPubMedSearch in Google Scholar
  • 19 Keene N. Your Child in the Hospital: A Practical Guide for Parents. Childhood Cancer Guides;; 2015
    Search in Google Scholar
  • 20 Gavrielov-Yusim N, Friger M. Use of administrative medical databases in population-based research. J Epidemiol Community Health 2014; 68 (03) 283-287
    CrossrefPubMedSearch in Google Scholar