Abstract
BACKGROUND AND OBJECTIVES: Acute appendicitis (AA) is a frequent surgical emergency. Although laparoscopic appendectomy (LA) is associated with favorable postoperative outcomes, open appendectomy (OA) remains widely used. Surgical site infection (SSI) is a common complication, with obesity recognized as a risk factor. However, body mass index (BMI) may not reliably reflect fat distribution. Subcutaneous fat thickness (SFT) measured on computed tomography (CT) may offer improved predictive value for surgical outcomes. METHODS: This retrospective study included 1,231 patients who underwent LA or OA for AA between 2017 and 2022. Preoperative SFT was measured on CT, and patients were analyzed by surgical technique and SFT subgroups. Postoperative complications, including SSI, were recorded. Receiver operating characteristic (ROC) analysis identified the SFT threshold associated with increased SSI risk. RESULTS: Despite similar BMI values between groups, SFT was significantly higher in LA patients (P < .001), highlighting the nonlinear relationship between BMI and SFT. LA was associated with shorter operative time (P = .004), reduced hospital stay (P = .009), and lower SSI rate (5.6% vs 13.5%, P < .001). Among patients with SFT ≥33 mm, LA resulted in significantly fewer SSIs (22 vs 50, P < .001) and shorter hospitalizations. ROC analysis confirmed SFT ≥33 mm as a strong predictor of SSI (area under the curve [AUC] = 0.841). CONCLUSION: LA offers superior outcomes compared to open surgery, particularly in patients with higher SFT. The discrepancy between BMI and SFT underscores the need for direct fat measurement in surgical risk assessment. Incorporating SFT into preoperative evaluation can guide optimal surgical strategy and improve patient outcomes.