title: The impact of obesity on laparoscopic appendectomy: Results from the ACS National Surgical Quality Improvement Program pediatric database.
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.
  
  
  METHODS
  Using the Pediatric National Surgical Quality Improvement Program (NSQIP) data from 2012, patients aged 2-18years 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.
authors.affiliation: Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric, Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Michailidou
authors.affiliation: Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric, Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Sacco Casamassima
authors.affiliation: Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric, Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Goldstein
authors.affiliation: Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: Gause
authors.affiliation: Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric, Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Karim
authors.affiliation: Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric, Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago & Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: fa@jhmi.edu.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D063766:Pediatric Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012307:Risk Factors
keywords: Laparoscopic appendectomy; NSQIP; Obesity; Outcomes; Pediatric