Timmerman Marjolijn E W, Groen Henk, Heineman Erik, Broens Paul M A
Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Int J Colorectal Dis. 2016 Aug;31(8):1467-73. doi: 10.1007/s00384-016-2614-6. Epub 2016 Jun 16.
The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children.
The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis of 457 children diagnosed with appendicitis. Based on BMI percentiles, patients were classified as either underweight (n = 36), normal weight (n = 346), overweight (n = 59), or obese (n = 16). Diagnosis accuracy was measured by negative appendectomy rate, perforation rate, and number of consultations. Treatment quality was measured by complication rate and length of hospital stay.
Underweight patients had the highest negative appendectomy (OR 3.00, P = 0.008) and complication (OR 2.75, P = 0.041) rate. BMI did not influence perforation rate or number of consultations. Both underweight and obese patients stayed in the hospital longer than normal weight patients (regression coefficient 2.34, P = 0.001, and regression coefficient 9.40, P < 0.001, respectively). Furthermore, in obese patients, the hospital stay after open appendectomy was prolonged compared to laparoscopic appendectomy (P < 0.001). No such differences were observed in patients with lower BMI.
Underweight children are misdiagnosed more often, stay in hospital longer, and experience more postoperative complications than children of normal weight. Obesity is associated with longer hospital stays. Laparoscopic appendectomy might shorten the length of hospital stays in these patients. We conclude that in addition to obesity, underweight should also be considered a risk factor for children with appendicitis.
从未有过关于较低体重指数（BMI）对阑尾炎影响的研究。我们调查了不同的BMI是否会影响儿童阑尾炎的诊断和治疗。
通过对457例诊断为阑尾炎的儿童进行回顾性分析，评估BMI与诊断准确性和治疗质量之间的相关性。根据BMI百分位数，将患者分为体重过轻（n = 36）、正常体重（n = 346）、超重（n = 59）或肥胖（n = 16）。诊断准确性通过阴性阑尾切除率、穿孔率和会诊次数来衡量。治疗质量通过并发症发生率和住院时间来衡量。
体重过轻的患者阴性阑尾切除率（OR 3.00，P = 0.008）和并发症发生率（OR 2.75，P = 0.041）最高。BMI不影响穿孔率或会诊次数。体重过轻和肥胖的患者住院时间均比正常体重的患者长（回归系数分别为2.34，P = 0.001和回归系数9.40，P < 0.001）。此外，肥胖患者开腹阑尾切除术后的住院时间比腹腔镜阑尾切除术后延长（P < 0.001）。较低BMI的患者未观察到此类差异。
与正常体重的儿童相比，体重过轻的儿童更容易被误诊，住院时间更长，术后并发症更多。肥胖与更长的住院时间有关。腹腔镜阑尾切除术可能会缩短这些患者的住院时间。我们得出结论，除肥胖外，体重过轻也应被视为儿童阑尾炎的一个危险因素。
