The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children.
OBJECTIVE
The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children.


METHODS
The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis of 457 children diagnosed with appendicitis. Based on BMI percentiles, patients were classified as either underweight (n = 36), normal weight (n = 346), overweight (n = 59), or obese (n = 16). Diagnosis accuracy was measured by negative appendectomy rate, perforation rate, and number of consultations. Treatment quality was measured by complication rate and length of hospital stay.


RESULTS
Underweight patients had the highest negative appendectomy (OR 3.00, P = 0.008) and complication (OR 2.75, P = 0.041) rate. BMI did not influence perforation rate or number of consultations. Both underweight and obese patients stayed in the hospital longer than normal weight patients (regression coefficient 2.34, P = 0.001, and regression coefficient 9.40, P < 0.001, respectively). Furthermore, in obese patients, the hospital stay after open appendectomy was prolonged compared to laparoscopic appendectomy (P < 0.001). No such differences were observed in patients with lower BMI.


CONCLUSIONS
Underweight children are misdiagnosed more often, stay in hospital longer, and experience more postoperative complications than children of normal weight. Obesity is associated with longer hospital stays. Laparoscopic appendectomy might shorten the length of hospital stays in these patients. We conclude that in addition to obesity, underweight should also be considered a risk factor for children with appendicitis.
Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. m.timmerman01@umcg.nl.
Marjolijn E W
ME
Timmerman
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Henk
H
Groen
Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Erik
E
Heineman
Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.|Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Paul M A
PM
Broens
D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D009765:Obesity / Q000150:complications*; D013851:Thinness / Q000150:complications*; D016896:Treatment Outcome
Appendectomy; Appendicitis; Body mass index; Obesity; Underweight