Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas.
Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
Ann Surg. 2023 Sep 1;278(3):337-346. doi: 10.1097/SLA.0000000000005965. Epub 2023 Jun 15.
To investigate the association between body mass index (BMI) spectrum and complicated appendicitis and postoperative complications in pediatric patients.
Despite the impact of being overweight and obese on complicated appendicitis and postoperative complications, the implications of being underweight are unknown.
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.
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).
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.
探讨儿童患者体重指数（BMI）谱与复杂性阑尾炎及术后并发症的关系。
尽管超重和肥胖对复杂性阑尾炎和术后并发症有影响，但体重不足的影响尚不清楚。
使用 NSQIP（2016-2020 年）数据对儿科患者进行回顾性分析。将患者的 BMI 百分位分为体重不足、正常体重、超重和肥胖。将 30 天术后并发症分为轻微、严重和任何一种。进行单变量和多变量逻辑回归模型分析。
在 23153 名患者中，体重不足患者复杂性阑尾炎的几率高出 66%[比值比（OR）=1.66；95%置信区间（CI）：1.06-2.59]，超重患者则低 28%（OR=0.72；95%CI：0.54-0.95）。超重和术前白细胞（WBC）之间存在统计学显著的相互作用，增加了复杂性阑尾炎的几率（OR=1.02；95%CI：1.00-1.03）。与正常体重患者相比，肥胖患者发生轻微并发症的几率高出 52%（OR=1.52；95%CI：1.18-1.96），体重不足患者发生严重并发症的几率高出 3 倍（OR=2.77；95%CI：1.22-6.27）和任何并发症（OR=2.82；95%CI：1.31-6.10）的几率。体重不足和术前 WBC 之间存在统计学显著的相互作用，降低了严重并发症（OR=0.94；95%CI：0.89-0.99）和任何并发症（OR=0.94；95%CI：0.89-0.98）的几率。
体重不足、超重以及超重和术前 WBC 之间的相互作用与复杂性阑尾炎有关。肥胖、体重不足以及体重不足和术前 WBC 之间的相互作用与轻微、严重和任何并发症有关。因此，针对高风险患者制定个性化的临床路径和家长教育可以最大程度地减少术后并发症。
