Appendicitis in the obese child

Background/Purpose: Little data exist that examine the surgical challenges of obese children. We hypothesize that obesity affects the presentation, diagnosis, surgery, and postoperative course in children with appendicitis. Methods: Cases of all children treated for appendicitis over 6 years were reviewed retrospectively. Demographics, presentation, pathology, and hospital course were examined. Results: A total of 282 cases were reviewed; 25 were moderately obese and 31 very obese (VO), which were defined, respectively, as greater than 1.5 and greater than 2 standard deviations above the standardized mean weight for age. Groups were similar in age, sex, presentation, use of ultrasound, and surgical management. Compared with the nonobese group, median operative time was higher in the VO group (63.5 vs 55.5 minutes; P = .028), with the association between obesity and longer operative time maintained when stratifying for perforated/nonperforated and open/laparoscopic cases. Almost twice as many VO children were in the hospital for more than 5 days (nonobese 23.6%, VO 40.0% [odds ratio, 2.2; 95% confidence interval, 0.99-4.8]). This association between obesity and longer length of stay was seen when stratifying for both perforated and nonperforated cases. In the perforated group, higher rates of postoperative wound infections and significantly longer times to full diet and ambulation likely contributed to these longer stays. Conclusions: Childhood obesity is associated with longer surgery and hospital stays and increased risk of postoperative infections. Obesity should be considered an important variable when looking at surgical outcomes in the pediatric population.