Appendectomy Hospital Stay: No Difference in Obese Adult or Pediatric Patient Length of Stay Compared to Nonobese Patients

摘要

Background: Studies of adult and pediatric patients undergoing appendectomy have reported variable outcomes and operative metrics related to the effect of obesity. The purpose of this study was to investigate the effect of obesity in adult and pediatric patients undergoing appendectomy at our institution.Methods: This single-center retrospective study evaluated the relationship between length of hospital stay for appendectomy and body mass index (BMI). Data obtained from the electronic medical record included age, sex, weight, height, BMI, the number of hours the patient experienced symptoms prior to presentation to the emergency room, the number of hours the patient was admitted prior to surgery, the number of hours of hospital admission after surgery, perforated appendix, preoperative comorbidities, and evidence of preoperative sepsis.Results: During the 3-year study period, 118 adults and 38 children who underwent appendectomy composed the study groups. Patients were stratified by obese and nonobese, with obesity defined as BMI ≥30.0 kg/m~(2). In adults, we found no significant difference between length of stay in obese (n=45) and nonobese (n=73) patients (79.6 ± 65.5 hours vs 101.6 ± 123.0 hours; P =0.21). In children, we found no significant difference between length of stay in obese (n=9) and nonobese (n=29) patients (92.9 ± 64.6 hours vs 109.0 ± 93.5 hours; P =0.54).Conclusion: Obesity did not affect length of stay in adults and children who underwent appendectomy in the present series. Keywords: Appendectomy , body mass index , inpatients , length of stay , obesity , postoperative complications INTRODUCTIONAppendectomy is one of the most common surgical procedures worldwide, whether performed for management of acute appendicitis or as an addition to a larger abdominal surgery.~(1) In the United States, approximately 200,000 appendectomies are performed annually.~(1) As such, patients undergoing appendectomy represent a sizable proportion of the general surgery patient population, and obesity may be an important factor in determining patient morbidity related to appendectomy performed for management of acute appendicitis.Albeit not specific to appendectomy, studies suggest that high body mass index (BMI) is positively associated with in-hospital mortality and increased length of stay (LOS).~(2,3) Akinyemiju et al concluded that higher BMI was associated with increased risk of mortality and longer hospital stay in a cohort of more than 800,000 patients admitted for various medical and cancer-related diagnoses.~(2) Similarly, Lewis et al found that obesity was associated with increased comorbid illness and with significantly longer intensive care unit and hospital LOS.~(3) However, in a cohort of 272 patients who underwent appendectomy, no significant differences were found in postoperative recovery, appendix perforation status, or mortality between obese and nonobese patients, and Towfigh et al recommended no change in appendicitis management for obese patients.~(4) A study of a large national pediatric database that compared patients who underwent appendectomy to patients undergoing other intestinal operations showed that obese appendectomy pediatric patients had significantly longer hospital LOS compared nonobese patients, but no significant difference in LOS was seen between obese and nonobese patients undergoing other intestinal operations.~(5) Other studies have reported worse outcomes in obese adults and longer operating times in obese adults and children.~(6-8) The purpose of this study was to investigate the effect of obesity in adult and pediatric patients undergoing appendectomy at our institution.METHODSThis study is a retrospective analysis of adult and pediatric populations who had an appendectomy at our institution during a 3-year period. Review of electronic medical records was conducted after obtaining institutional review board approval. Obesity was defined as BMI ≥30.0 kg/m~(2). Data obtained from the electronic medical record included age, sex, weight, height, BMI, the number of hours the patient experienced symptoms prior to presentation to the emergency room, the number of hours the patient was admitted prior to surgery, and the number of hours of hospital admission after surgery. International Classification of Diseases, Tenth Revision codes were used to identify perforation status of the appendix. All cases were also reviewed for evidence of appendix perforation by direct intraoperative visualization, preoperative comorbidities, and evidence of preoperative sepsis. Sepsis was defined as having at least 2 of the following in the presence of possible infection: central body temperature >101 °F (38.3 °C) or <96.8 °F (36 °C), heart rate ≥90 bpm, or respiratory rate ≥20 breaths per minute.~(9) For comorbidities, each condition was recorded, and a comorbidity score (0, 1, or ≥2) was created as the sum of the number of conditions per patient. BMI was stratified, and LOS was then compa