Impact of body mass index on perioperative outcomes and short-term recovery profiles of single-incision laparoscopic appendectomy: a propensity score-matched analysis

Objective This study aimed to evaluate the association between stratified body mass index (BMI) and the intraoperative outcomes and short-term postoperative recovery profiles of patients undergoing single-incision laparoscopic appendectomy (SILA), utilizing a propensity score-matched (PSM) analysis to minimize baseline selection bias and confounding clinical factors. Methods Clinical data of 282 patients who underwent SILA between January 2024 and January 2026 were retrospectively analyzed, comprising 93 patients in the normal weight group, 97 in the overweight group, and 92 in the obesity group. To control for baseline confounding, a 1:1 nearest-neighbor PSM with a strict caliper of 0.02 was performed based on preoperative covariates, including age, gender, comorbidities, history of abdominal surgery, preoperative delay, and pathological diagnosis. Intraoperative parameters and postoperative recovery profiles were subsequently compared among the matched groups. Results After 1:1 propensity score matching, a well-balanced cohort was successfully analyzed, with all preoperative baseline variables closely aligned (all P > 0.05). In the matched cohort, appendiceal length and width showed no statistical differences among the stratified groups ( P > 0.05). Importantly, no patients required conversion to open surgery. However, higher BMI was associated with a stepwise prolongation of operative time ( P = 0.002) and greater intraoperative blood loss ( P < 0.001). Postoperatively, the time to first flatus was longer in patients with higher BMI ( P < 0.001). Furthermore, higher BMI was associated with elevated postoperative pain scores ( P < 0.001) and a higher incidence of gastrointestinal adverse reactions, including nausea/vomiting ( P = 0.008), abdominal distension ( P = 0.001), and diarrhea ( P = 0.006). Conclusion While single-incision laparoscopic appendectomy remains safe and technically feasible, an elevated BMI was associated with impaired operative efficiency, more intense early postoperative pain, and slower short-term gastrointestinal recovery. Clinicians should fully weigh these hidden recovery costs and metabolic stress profiles during perioperative management for overweight and obese patients.