The Impact of Body Mass Index and Presenting Institution on Diagnostic Imaging for Children Undergoing Appendectomy.

PURPOSE: Children with excess weight experience disparities in healthcare delivery. We sought to investigate whether pediatric obesity is associated with differences in appendicitis workup and whether these vary by presenting institution. METHODS: The American College of Surgeons National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database was retrospectively surveyed for patients undergoing appendectomy from 2018 to 2022. Patients < 2 or > 18 years, non-binary sex, missing body mass index (BMI) data, or those with biologically implausible BMI percentiles were excluded. 72,749 patients met the inclusion criteria. Multivariate regression analysis was performed to assess the effect of BMI category and presenting institution on preoperative imaging. RESULTS: Children with excess weight are more likely to undergo CT (overweight: aOR 1.23[95%CI 1.17–1.28], obese: 1.61[1.54–1.69], severely obese: 2.41[2.27–2.57]) and less likely to undergo ultrasound (overweight: 0.82[0.78–0.86], obese 0.66[0.63–0.70], severely obese: 0.47[0.44–0.50]). There is a significant interaction between BMI category and presenting institution (CT: p < 0.0001, ultrasound: p = 0.0013), with a more pronounced relationship seen at NSQIP-P institutions. CONCLUSIONS: Diagnostic evaluation for pediatric appendicitis varies by BMI category and presenting institution. Children with excess weight, particularly those presenting to non-NSQIP-P institutions, are more likely to undergo CT and less likely to receive ultrasound, increasing risk for long-term negative health consequences.