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Updated: Jul 26, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Body Mass Index Is Associated With Pediatric Complicated Appendicitis and Postoperative Complications
Nutan B Hebballi1,2, Stacia DeSantis3, Eric L Brown1
1Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas.
Insights
Underweight children face higher risks of complicated appendicitis and major postoperative complications, while overweight children have lower odds of complicated appendicitis. Personalized care is crucial for at-risk pediatric patients.
Area of Science:
- Pediatric Surgery
- Clinical Outcomes Research
- Obesity and Health
Background:
- The impact of being overweight or obese on complicated appendicitis and postoperative complications is known, but the effects of being underweight remain unclear.
- Investigating the full spectrum of body mass index (BMI) in relation to appendicitis outcomes is essential for comprehensive patient care.
Purpose of the Study:
- To examine the association between various body mass index (BMI) categories and the occurrence of complicated appendicitis in pediatric patients.
- To determine the relationship between BMI spectrum and the incidence of minor, major, and any postoperative complications following appendicitis treatment in children.
Main Methods:
- A retrospective analysis of pediatric patients' data was conducted using the National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2020.
- Patients' body mass index (BMI) percentiles were classified into underweight, normal weight, overweight, and obese categories.
- Statistical analyses, including univariate and multivariable logistic regression, were performed to assess the associations between BMI and appendicitis outcomes.
Main Results:
- Underweight pediatric patients had significantly higher odds of complicated appendicitis (OR=1.66) compared to normal-weight patients.
- Overweight patients demonstrated lower odds of complicated appendicitis (OR=0.72), with a significant interaction between overweight status and preoperative white blood cell (WBC) counts.
- Obese patients experienced increased odds of minor complications (OR=1.52), while underweight patients faced substantially higher odds of major (OR=2.77) and any (OR=2.82) postoperative complications.
Conclusions:
- Body mass index (BMI) spectrum, including underweight and overweight status, is significantly associated with complicated appendicitis in pediatric patients.
- Obesity and underweight are linked to increased postoperative complications, with significant interactions involving preoperative white blood cell (WBC) counts.
- Developing personalized clinical pathways and targeted parental education for at-risk pediatric populations can effectively mitigate postoperative complications associated with appendicitis.
Objective:
To investigate the association between body mass index (BMI) spectrum and complicated appendicitis and postoperative complications in pediatric patients.
Background:
Despite the impact of being overweight and obese on complicated appendicitis and postoperative complications, the implications of being underweight are unknown.
Methods:
A retrospective review of pediatric patients was conducted using NSQIP (2016-2020) data. Patient's BMI percentiles were categorized into underweight, normal weight, overweight, and obese. The 30-day postoperative complications were grouped into minor, major, and any. Univariate and multivariable logistic regression models were performed.
Results:
Among 23,153 patients, the odds of complicated appendicitis were 66% higher in underweight patients [odds ratio (OR)=1.66; 95% CI: 1.06-2.59] and 28% lower in overweight patients (OR=0.72; 95% CI: 0.54-0.95) than normal-weight patients. A statistically significant interaction between overweight and preoperative white blood cells (WBCs) increased the odds of complicated appendicitis (OR=1.02; 95% CI: 1.00-1.03). Compared to normal-weight patients, obese patients had 52% higher odds of minor (OR=1.52; 95% CI: 1.18-1.96) and underweight patients had 3 times the odds of major (OR=2.77; 95% CI: 1.22-6.27) and any (OR=2.82; 95% CI: 1.31-6.10) complications. A statistically significant interaction between underweight and preoperative WBC lowered the odds of major (OR=0.94; 95% CI: 0.89-0.99) and any complications (OR=0.94; 95% CI: 0.89-0.98).
Conclusions:
Underweight, overweight, and interaction between overweight and preoperative WBC were associated with complicated appendicitis. Obesity, underweight, and interaction between underweight and preoperative WBC were associated with minor, major, and any complications. Thus, personalized clinical pathways and parental education targeting at-risk patients can minimize postoperative complications.
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