Obesity Paradox in Pediatric Gallbladder Pathology

INTRODUCTION: Obesity in the pediatric population has increased in parallel with the rise in pediatric cholecystectomy case volume; however, the perioperative impact of obesity remains unclear in this population. This study investigates the relationship between obesity and surgical complexity and outcomes in pediatric cholecystectomy. METHODS: Data from 2020 to 2022 were collected from the National Surgical Quality Improvement Program on patients aged 2- 20 y who underwent cholecystectomy. Body mass index classification was performed using Centers for Disease Control and Prevention body mass index for age data, with obesity defined as ≥95th percentile. Analysis categories included total length of stay, operation time, case acuity, unplanned conversion from laparoscopic to open, and complications including surgical site infections, unplanned reintubation, transfusions, sepsis, and secondary interventions. RESULTS: Of 10,846 patients, 3904 were classified as normal weight and 6942 as obese. The obese group had a longer mean operation time (P < 0.001). In the obese group, there were significantly more instances of unplanned laparoscopic to open conversions (P = 0.016). There were significantly more complications in the normal-weight group, specifically unplanned intubation (P = 0.040), transfusions (P < 0.001), and unplanned reoperation (P = 0.002). CONCLUSIONS: Pediatric obesity may be associated with longer procedural time in patients undergoing cholecystectomy, but obesity was not found to be associated with adverse postoperative outcomes.