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Impact of Pediatric Obesity on Operative Duration and Postoperative Outcomes in Common Laparoscopic Surgery
Josélio Rodrigues de Oliveira Filho1,2, Ghadeer Shnawa1,2, Reagan Collins3, Matthew Hornick4, Jun Tashiro5, James Healy6, Christine Finck6, Kanika Bowen-Jallow7, Jeffrey L. Zitsman8, Gillian L. Fell9, Janey S. Pratt9, Cornelia L. Griggs1,2 1Division of Pediatric Surgery, Mass General Brigham, Boston, MA 2Harvard Medical School, Boston, MA 3Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 4Division of Pediatric Surgery, Yale New Haven Hospital, New Haven, CT 5Department of Surgery, NYU Grossman School of Medicine, New York, NY 6Department of Surgery, Connecticut Children's Medical Center, Hartford, CT 7Department of Surgery, Cook Children's Medical Center, Fort Worth, TX 8Department of Surgery, Columbia University Medical Center, New York, NY 9Department of Surgery, Stanford University, Stanford, CA
Background: Pediatric obesity may increase technical and anesthetic complexity, but its association with perioperative duration and short-term outcomes after common laparoscopic operations remains incompletely defined. Methods: We analyzed ACS NSQIP-Pediatric (2012-2024). Children aged 2-17 years undergoing laparoscopic appendectomy or cholecystectomy were included if BMI category, operative and anesthesia duration, and prespecified covariates were available. Procedure-specific multivariable linear models estimated adjusted percent differences in operative and anesthesia time by BMI category. Logistic regression evaluated associations between time, per 10-minute increase, and 30-day complications. Excess operating room costs were projected using published per-minute rates. Results: Among 183,923 children (151,298 appendectomies; 32,625 cholecystectomies), higher BMI category was associated with progressively longer operative and anesthesia times. For class III obesity, absolute differences ranged from approximately 7 to 12 additional operative minutes and 11 to 14 additional anesthesia minutes. P-for-trend was <0.001 for all procedure-time combinations, and associations were stable across the study period. Longer operative time was associated with higher adjusted odds of organ/space surgical-site infection, systemic sepsis, reoperation, prolonged ventilation, readmission, and bleeding/transfusion. Anesthesia time associations were directionally similar but smaller. The BMI-associated time burden translated to an estimated $13.3 million in excess operating costs over the study period, approximately $1 million annually. Conclusion: Higher BMI category was associated with a measurable, graded perioperative time burden across common pediatric laparoscopic procedures, with substantial cumulative cost. Operative and anesthesia time may serve as clinically meaningful process measures of perioperative complexity and should inform case-duration estimation, anesthesia preparation, equipment readiness, and resource allocation.
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