Influence of overweight and obesity on acute appendicitis in children. A cohort study.

Introduction: Overweight and obesity are risk factors for the development of postsurgical complications in acute appendicitis in adults. However, there are few studies that evaluate their effects in pediatric patients. We aim to analyze their influence on the postoperative course of acute appendicitis in children.

Material And Methods: A prospective cohort study was performed in patients undergoing surgery for acute appendicitis in 2017-2018, divided into two cohorts according to BMI adjusted to sex and age, following the WHO criteria: exposed cohort (overweight-obese) and non-exposed cohort (normal weight). Clinical follow-up was performed during hospital admission and one month after surgery. Demographic variables, operating time, average hospital stay, and early postoperative complications (wound infection, wound dehiscence, and intra-abdominal abscess) were assessed.

Results: A total of 403 patients were included (exposed cohort n=97 and non-exposed cohort n=306), with no differences in sex or age. A longer operating time was observed in the exposed cohort (57.6 ± 22.5 vs. 44.6 ± 18.2 min, p<0.001), with no differences found according to the surgical approach (open surgery or laparoscopic surgery) used. This group also had a higher surgical wound infection rate as compared to the non-exposed cohort (10.3% vs. 4.2%; RR: 1.90; CI: 95% [1.15-3.14], p<0.001), as well as a higher surgical wound dehiscence rate (7.2% vs. 2.3%; RR: 2.16; CI: 95% [1.24-3.76], p<0.001). No differences in the development of intra-abdominal abscesses or in hospital stay were observed.

Conclusions: Obese and overweight children with appendicitis have a higher risk of developing postoperative complications such as wound infection and dehiscence than normal weight patients.