The impact of obesity on laparoscopic appendectomy: Results from the ACS National Surgical Quality Improvement Program pediatric database

Michailidou, Maria; Casamassima, Maria Grazia Sacco; Goldstein, Seth D.; Gause, Colin D.; Karim, Omar; Salazar, Jose H.; Yang, Jingyan

doi:10.1016/j.jpedsurg.2015.07.005

Cited by 24 publications

(23 citation statements)

References 34 publications

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“…Our data supports these findings, despite the rarity of this event in our data. We also observed a significant increase in operative time, which is consistent with the existing literature[18, 19, 22], and may indicate technical challenges associated with abdominal wall depth and intra-abdominal adiposity.…”

Section: 4 Discussionsupporting

confidence: 91%

“…We believe that there are two primary reasons why our finding that BMI percentile was associated with complications of any type differ from the results observed by Michailidou using the same NSQIP Pediatric dataset[22]. First, we included open appendectomy, elective cases, and two years of data rather than one (9,606 patients compared with 2,812) to increase our sample size and were, therefore, powered to detect different outcomes.…”

Section: 4 Discussionmentioning

confidence: 96%

“…In pediatric urologic surgery patients undergoing either genital or abdominal procedures, obese children had higher rates of overall and wound complications[21]. Recently, Michailidou studied complications following urgent or emergent laparoscopic appendectomy in 2,812 pediatric patients in the Pediatric National Surgical Quality Improvement Program dataset[22]. When comparing obese to non-obese patients, they demonstrated no difference in complications albeit longer operative duration for obese patients.…”

Section: 1 Backgroundmentioning

confidence: 99%

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Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes

Witt

Goldin

Vavilala

et al. 2016

Journal of Pediatric Surgery

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Background/Purpose Pediatric obesity is an important public health concern, yet its effect on surgical outcomes is poorly understood. The purpose of this study was to determine if age and gender-specific body mass index (BMI) percentile influences complications and hospital resource utilization following pediatric gastrointestinal surgeries. Methods Patients aged age ≥2 to <18 years who underwent appendectomy or other gastrointestinal operations were identified in the 2012 - 2013 Pediatric National Surgical Quality Improvement Program datasets. Age- and gender-specific pediatric BMI percentiles were calculated. Patients who underwent appendectomy (n=9,606) and those undergoing all other intestinal operations (n=2,664) were evaluated as separate cohorts. Results In the appendectomy cohort, frequency of any complication increased with BMI category (normal-weight 4.5%, overweight 5.3%, obese 5.7%, morbidly obese 7.3%, overall 5.0%, p = 0.014). In multivariable analysis, there was a quadratic association between BMI percentile and increased frequency of superficial incisional infection, unplanned tracheal intubation, and longer operative duration. In the intestinal surgery cohort, BMI percentile was not a predictor of any individual complication or any measure of hospital utilization. Conclusions Age- and gender-specific BMI percentile was associated with increased risk of complications and longer operative duration in patients undergoing appendectomy but not other intestinal operations.

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Section: 4 Discussionsupporting

confidence: 91%

Section: 4 Discussionmentioning

confidence: 96%

Section: 1 Backgroundmentioning

confidence: 99%

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Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes

Witt

Goldin

Vavilala

et al. 2016

Journal of Pediatric Surgery

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“…Results from the American College of Surgeons NSQIP (pediatric database) demonstrated that obesity was not found to be an independent risk factor for postoperative complications following LA. Although operative time was increased in obese children, obesity did not increase the likelihood of 30-day postoperative complications [155].…”

Section: Q44: Does Laparoscopic Single-incision Surgery Confer Any mentioning

confidence: 84%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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“…Kurtz et al 19 analyzed data from the Pediatric National Surgical Quality Improvement Program Database (NSQIP) and found an increase in the odds of overall complications by 36% and wound complications by 138% for patients aged 2−18 years with a BMI greater than the 85th percentile in patients undergoing urologic procedures. While a similar data analysis of NSQIP data for appendectomy surgery patients showed no difference in complication rate, researchers did report that operative time was increased to a level of significance for obese children 20 . Children who are overweight are also more likely to have type 2 diabetes, hypertension, and asthma 21 .…”

Section: Impact Of Malnutrition On Surgical Outcomesmentioning

confidence: 98%

Optimizing Perioperative Nutrition in Pediatric Populations

et al. 2015

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Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period.

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The impact of obesity on laparoscopic appendectomy: Results from the ACS National Surgical Quality Improvement Program pediatric database

Cited by 24 publications

References 34 publications

Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes

Effect of body mass index percentile on pediatric gastrointestinal surgery outcomes

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Optimizing Perioperative Nutrition in Pediatric Populations

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