title: Obesity Increases Operative Time in Children Undergoing Laparoscopic Cholecystectomy.
abstract: BACKGROUND
  Few studies have assessed the impact of obesity on laparoscopic cholecystectomy (LC) in pediatric patients.
  
  
  METHODS
  Children who underwent LC were identified from the 2012 to 2013 American College of Surgeons' National Surgical Quality Improvement Program Pediatrics data. Patient characteristics, operative details, and outcomes were compared. Multivariable logistic regression was utilized to identify predictors of increased operative time (OT) and duration of anesthesia (DOAn).
  
  
  RESULTS
  In total, 1757 patients were identified. Due to low rates of obesity in children <9 years old, analyses were limited to those 9-17 (n = 1611, 43% obese). Among obese children, 80.6% were girls. A higher proportion of obese patients had diabetes (3.0% versus 1.0%, P < .01) and contaminated or dirty/infected wounds (15.1% versus 9.4%, P < .01). Complication rates were low. The most frequent indications for surgery were cholelithiasis/biliary colic (34.3%), chronic cholecystitis (26.9%), and biliary dyskinesia (18.2%). On multivariable analysis, obesity was an independent predictor of OT >90 (odds ratio [OR] 2.02; 95% confidence interval [95% CI] 1.55-2.63), and DOAn >140 minutes (OR 1.86; 95% CI 1.42-2.43).
  
  
  CONCLUSIONS
  Obesity is an independent risk factor for increased OT in children undergoing LC. Pediatric surgeons and anesthesiologists should be prepared for the technical and physiological challenges that obesity may pose in this patient population.
authors.affiliation: 1 Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic , Rochester, Minnesota.
authors.forename: T K
authors.initials: TK
authors.lastname: Pandian
authors.affiliation: 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ubl
authors.affiliation: 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: 3 Division of Pediatric Surgery, Department of Surgery, Mayo Clinic , Rochester, Minnesota.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: 3 Division of Pediatric Surgery, Department of Surgery, Mayo Clinic , Rochester, Minnesota.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ishitani
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors
keywords: anesthesia duration; cholelithiasis; laparoscopic cholecystectomy; obesity; operative time; surgical site infection