Obesity and perioperative outcomes in pediatric laparoscopic appendectomy: a retrospective, propensity score-matched...

The global surge in childhood obesity introduces new complexities to pediatric surgical management. While obesity correlates with adverse outcomes in adult appendectomy, its impact on pediatric laparoscopic appendectomy remains poorly defined due to methodological limitations in existing studies. This study aimed to isolate the independent effect of obesity on perioperative outcomes in children undergoing laparoscopic appendectomy using propensity score matching (PSM) that rigorously controls for confounding variables.

This retrospective cohort study analyzed 549 pediatric patients (aged 2-18 years) with acute appendicitis treated at a tertiary center [2021-2025]. Patients were stratified into two groups based on body mass index (BMI): the normal weight group (NW, BMI <85th percentile) and the overweight/obesity group (OW/OB, BMI ≥85th percentile). A 3:1 PSM balanced key covariates (age, perforation status, surgical approach, etc.), yielding 448 matched patients (327 NW; 121 OW/OB). Primary outcomes included operative time, blood loss, surgical site infection (SSI), and hospitalization duration.

After PSM, OW/OB patients had significantly longer operative time (median 45 vs. 41 min, P=0.02), higher absolute estimated blood loss (median 5 vs. 3 mL, P=0.001), and increased SSI rates (6.6% vs. 2.7%, P=0.04). However, blood loss per kilogram was similar (P=0.64), and no differences were found in overall complications (14.1% vs. 15.6%, P=0.89), Clavien-Dindo severity, length of stay (median 5.5 days both, P=0.93), or 30-day readmissions (0.8% vs. 0.9%, P>0.99).

Obesity independently increases technical challenges (prolonged surgery and bleeding) and SSI risk in pediatric laparoscopic appendectomy but does not affect overall complication rates or recovery metrics such as hospitalization duration.