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Li ZW, Song M, Liu J, Jiang B, Hu W, Zheng X. Is the recurrence rate higher in obese patients undergoing inguinal hernia surgery? Hernia 2025; 29:107. [PMID: 40000506 DOI: 10.1007/s10029-025-03301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 02/16/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE This study aimed to evaluate whether obese patients undergoing inguinal hernia repair surgery have a higher recurrence rate and compare the clinical outcomes of obese and non-obese patients. MATERIALS AND METHODS The databases of PubMed, EMBASE, and Cochrane Library were used to search for eligible studies from inception to November 1, 2024. Mean difference (MD), Odds ratios (OR) and 95% confidence intervals (Cl) were pooled up to analyze. The Newcastle-Ottawa Scale (NOS) scores were used to evaluate the quality of the included studies. This study was performed with Stata (V.16.0) software. RESULTS A total of nine studies involving 56,833 patients were included in this study. By comparing the baseline information, we found that the obese group had Fewer older (MD=-0.08, I²=62.41%, 95%CI=-0.16 to -0.00, P = 0.04), higher BMI (MD = 2.45, I²=93.67%, 95%CI = 2.08 to 2.81, P < 0.01), more hypertension patients (OR = 1.32, I²=32.96%, 95%CI = 1.02 to 1.67, P = 0.04), more BPH (OR = 0.68, I²=0.00%, 95%CI = 0.49 to 0.94, P = 0.02) and more local anesthesia (OR = 0.82, I²=14.73%, 95%CI = 0.79 to 0.86, P < 0.01) than the none-obese group. In terms of postoperative outcomes, We found that the obese group had higher recurrence rate (OR = 1.27, I²=21.89%, 95%CI = 1.10 to 1.47, P < 0.01), more wound infection (OR = 1.43, I²=0.00%, 95%CI = 1.20 to 1.69, P < 0.01), and more overall complications (OR = 1.12, I²=28.20%, 95%CI = 1.05 to 1.20, P < 0.01). CONCLUSION Compared with the non-obese group, the obese group has a higher recurrence rate, more wound infections, and overall more complications.
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Affiliation(s)
- Zi-Wei Li
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Ming Song
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Jun Liu
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Bin Jiang
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Wei Hu
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Xin Zheng
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China.
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Aceto P, De Cicco R, Calabrese C, Marusco I, Del Tedesco F, Luca E, Modesti C, Sacco T, Sollazzi L, Ciccoritti L, Greco F, Giustacchini P, Pennestrì F, Gallucci P, Raffaelli M. Obesity Surgery Mortality Risk Score as a Predictor for Intensive Care Unit Admission in Patients Undergoing Laparoscopic Bariatric Surgery. J Clin Med 2024; 13:2252. [PMID: 38673525 PMCID: PMC11050932 DOI: 10.3390/jcm13082252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Laparoscopic bariatric surgery provides many benefits including lower postoperative pain scores, reduced opioid consumption, shorter hospital stays, and improved quality of recovery. However, the anaesthetic management of obese patients requires caution in determining postoperative risk and in planning adequate postoperative pathways. Currently, there are no specific indications for intensive care unit (ICU) admission in this surgical population and most decisions are made on a case-by-case basis. The aim of this study is to investigate whether Obesity Surgery Mortality Risk Score (OS-MRS) is able to predict ICU admission in patients undergoing laparoscopic bariatric surgery (LBS). Methods: We retrospectively reviewed data of patients who underwent LBS during a 2-year period (2017-2019). The collected data included demographics, comorbidities and surgery-related variables. Postoperative ICU admission was decided via bariatric anaesthesiologists' evaluations, based on the high risk of postoperative cardiac or respiratory complications. Anaesthesia protocol was standardized. Logistic regression was used for statistical analysis. Results: ICU admission was required in 2% (n = 15) of the 763 patients. The intermediate risk group of the OS-MRS was detected in 84% of patients, while the American Society of Anaesthesiologists class III was reported in 80% of patients. A greater OS-MRS (p = 0.01), advanced age (p = 0.04), male gender (p = 0.001), longer duration of surgery (p = 0.0001), increased number of patient comorbidities (p = 0.002), and previous abdominal surgeries (p = 0.003) were predictive factors for ICU admission. Conclusions: ICU admission in obese patients undergoing LBS is predicted by OS-MRS together with age, male gender, number of comorbidities, previous abdominal surgeries, and duration of surgery.
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Affiliation(s)
- Paola Aceto
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto De Cicco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Claudia Calabrese
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Irene Marusco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Filippo Del Tedesco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Ersilia Luca
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Cristina Modesti
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Teresa Sacco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Liliana Sollazzi
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Ciccoritti
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Francesco Greco
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Piero Giustacchini
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Francesco Pennestrì
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pierpaolo Gallucci
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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McKechnie T, Lee Y, Hong D, Dionne J, Doumouras A, Parpia S, Bhandari M, Eskicioglu C. A history of bariatric surgery before surgery for colorectal cancer may improve short-term postoperative outcomes: Analysis of the national inpatient sample 2015-2019. Surgery 2023; 174:1168-1174. [PMID: 37709649 DOI: 10.1016/j.surg.2023.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective and sustainable form of weight loss. Bariatric surgery before elective operations for colorectal pathology may improve postoperative outcomes. To compare patients with and without prior bariatric surgery undergoing surgery for colorectal cancer in terms of postoperative morbidity and health care use. METHODS Adult patients undergoing resection for colorectal cancer from 2015 to 2019 were identified from the National Inpatient Sample. Patients were stratified according to their history of bariatric surgery. Propensity score matching with 4:1 nearest-neighbor matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, postoperative length of stay, total admission health care cost, and post-discharge disposition. McNemar's test and Wilcoxon matched-pairs signed-rank test were performed. RESULTS After propensity score matching, 1,197 patients without prior bariatric surgery and 376 patients with prior bariatric surgery were included. Patients with prior bariatric surgery had an absolute reduction of 6.5% in overall in-hospital postoperative morbidity (19.1% vs 25.6%, P < .0001), a $5,256 decrease in hospitalization cost ($70,344 vs $75,600, P = .034), and were more likely to be discharged home after their index operation (72.9% vs 63.9%, P < .0001). CONCLUSION Bariatric surgery before surgery for colorectal cancer may be associated with decreased postoperative morbidity and health care use. Bariatric surgery and other forms of rapid and effective weight loss, such as very low-energy diets, should be evaluated further for the optimization of obese patients before nonbariatric abdominal surgery.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/tylermckechnie
| | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA. https://twitter.com/YungLeeMD
| | - Dennis Hong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. https://twitter.com/Drbariatricsx
| | - Joanna Dionne
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. https://twitter.com/Doctor_Doum
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada.
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Liu Y, Bendersky VA, Chen X, Ghildayal N, Harhay MN, Segev DL, McAdams-DeMarco M. Post-kidney transplant body mass index trajectories are associated with graft loss and mortality. Clin Transplant 2023; 37:e14947. [PMID: 36811329 PMCID: PMC10175140 DOI: 10.1111/ctr.14947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Early post-kidney transplantation (KT) changes in physiology, medications, and health stressors likely impact body mass index (BMI) and likely impact all-cause graft loss and mortality. METHODS We estimated 5-year post-KT (n = 151 170; SRTR) BMI trajectories using an adjusted mixed effects model. We estimated long-term mortality and graft loss risks by 1-year BMI change quartile (decrease [1st quartile]: change < -.07 kg/m2 /month; stable [2nd quartile]: -.07 ≤ change ≤ .09 kg/m2 /month; increase [3rd, 4th quartile]: change > .09 kg/m2 /month) using adjusted Cox proportional hazards models. RESULTS BMI increased in the 3 years post-KT (.64 kg/m2 /year, 95% CI: .63, .64) and decreased in years 3-5 (-.24 kg/m2 /year, 95% CI: -.26, -.22). 1-year post-KT BMI decrease was associated with elevated risks of all-cause mortality (aHR = 1.13, 95% CI: 1.10-1.16), all-cause graft loss (aHR = 1.13, 95% CI: 1.10-1.15), death-censored graft loss (aHR = 1.15, 95% CI: 1.11-1.19), and mortality with functioning graft (aHR = 1.11, 95% CI: 1.08-1.14). Among recipients with obesity (pre-KT BMI≥30 kg/m2 ), BMI increase was associated with higher all-cause mortality (aHR = 1.09, 95% CI: 1.05-1.14), all-cause graft loss (aHR = 1.05, 95% CI: 1.01-1.09), and mortality with functioning graft (aHR = 1.10, 95% CI: 1.05-1.15) risks, but not death-censored graft loss risks, relative to stable weight. Among individuals without obesity, BMI increase was associated with lower all-cause graft loss (aHR = .97, 95% CI: .95-.99) and death-censored graft loss (aHR = .93, 95% CI: .90-.96) risks, but not all-cause mortality or mortality with functioning graft risks. CONCLUSIONS BMI increases in the 3 years post-KT, then decreases in years 3-5. BMI loss in all adult KT recipients and BMI gain in those with obesity should be carefully monitored post-KT.
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Affiliation(s)
- Yi Liu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nidhi Ghildayal
- Department of Surgery, New York University School of Medicine, New York, NY
| | - Meera N. Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
- Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania
| | - Dorry L. Segev
- Department of Surgery, New York University School of Medicine, New York, NY
- Department of Population, New York University School of Population Health, New York, NY
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Mara McAdams-DeMarco
- Department of Surgery, New York University School of Medicine, New York, NY
- Department of Population, New York University School of Population Health, New York, NY
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Berkman ER, Richardson KL, Clark JD, Dick AAS, Lewis-Newby M, Diekema DS, Wightman AG. An ethical analysis of obesity as a contraindication of pediatric kidney transplant candidacy. Pediatr Nephrol 2023; 38:345-356. [PMID: 35488137 DOI: 10.1007/s00467-022-05572-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/10/2023]
Abstract
The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant.
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Affiliation(s)
- Emily R Berkman
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kelsey L Richardson
- Division of Pediatric Nephrology, Oregon Health Sciences University, Portland, OR, USA
| | - Jonna D Clark
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - André A S Dick
- Division of Transplantation, Section of Pediatric Transplantation, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Mithya Lewis-Newby
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Cardiac Critical Care, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas S Diekema
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Aaron G Wightman
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Verhoeff K, Mocanu V, Jogiat U, Forbes H, Switzer NJ, Birch DW, Karmali S. Patient Selection and 30-Day Outcomes of SADI-S Compared to RYGB: a Retrospective Cohort Study of 47,375 Patients. Obes Surg 2022; 32:1-8. [PMID: 35445967 PMCID: PMC9022408 DOI: 10.1007/s11695-022-06068-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure with few comparative studies evaluating patient selection or perioperative outcomes. We aim to compare SADI-S to Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry was analyzed, comparing SADI-S to RYGB. Bivariate analysis was performed to determine intergroup differences. Multivariable logistic regression determined factors associated with serious complications and mortality. RESULTS We evaluated 47,375 patients, with 501 (1.1%) receiving SADI-S. Patients undergoing SADI-S had higher body mass index (51.4 ± 9.7 kg/m2 SADI-S vs. 44.6 ± 7.9 kg/m2 RYGB; p < 0.001), and more metabolic comorbidities including non-insulin dependent diabetes (21.7% SADI-S vs 19.0% RYGB; p = 0.011), insulin dependent diabetes (12.0% SADI-S vs. 8.6% RYGB; p = 0.011), and hypertension (54.9% SADI-S vs 47.6% RYGB; p < 0.001). Patients undergoing SADI-S experienced more anastomotic leaks (2.2% vs. 0.5%; p < 0.001), reoperations (5.0% vs 2.6%; p < 0.001), pneumonias (1.6% vs 0.5%; p < 0.001), had sepsis more frequently (1.4% vs 0.3%; p < 0.001), and required more unplanned reintubations (1.2% vs 0.3%; p = 0.004). SADI-S was independently associated with serious complications (OR 1.45, CI 1.09-1.95, p < 0.001) but was not a predictor of mortality (OR 3.29, p = 0.060). CONCLUSIONS In comparison to RYGB, patients undergoing SADI-S were found to have more metabolic comorbidities. Compared to RYGB, SADI-S has worse perioperative outcomes and is independently associated with serious complications. It remains unclear whether this represents a learning curve or true findings and prospective studies analyzing the risk-benefit ratio following SADI-S are needed.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hayley Forbes
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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Iijima Y, Ishikawa M, Iwai S, Yamagata A, Motono N, Uramoto H. Is Overweight Related to the Prognosis of Octogenarians with Lung Cancer? Obes Surg 2022; 32:1279-1288. [DOI: 10.1007/s11695-022-05948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
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Ruf CG, Krampe S, Matthies C, Anheuser P, Nestler T, Simon J, Isbarn H, Dieckmann KP. Major complications of post-chemotherapy retroperitoneal lymph node dissection in a contemporary cohort of patients with testicular cancer and a review of the literature. World J Surg Oncol 2020; 18:253. [PMID: 32972425 PMCID: PMC7517823 DOI: 10.1186/s12957-020-02032-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background Post-chemotherapy retroperitoneal lymph node dissection (pc-RPLND) is one cornerstone in the clinical management of patients with nonseminomatous testicular germ cell tumours (GCT). A wide range of complication rates in this type of surgery is reported so far. We retrospectively evaluated the frequency of major complications by using the Clavien-Dindo classification and analysed the influence of various clinical factors on complication rates in pc-RPLND. Methods We retrospectively analysed 146 GCT patients undergoing pc-RPLND. Complications of grade III–V according to the Clavien-Dindo classification occurring within 30 days after surgery were registered along with the following clinical factors: age, body mass index (BMI), duration of surgery, number of anatomic fields resected, side of primary tumour, histology of surgical specimen, histology of primary tumour, and total dose of cisplatin applied prior to surgery. For comparison, we also evaluated 35 chemotherapy-naïve patients with primary RPLND and 19 with laparoscopic RPLND. We analysed types and frequencies of the various complications as well as associations with clinical factors using descriptive statistical methods. Results A total of 14.4% grade III–IV complications were observed in pc-RPLND, and 8.6% and 5.3% in primary and in laparoscopic RPLND, respectively. There was no perioperative mortality. Lymphocele was the most frequent adverse event (16% of grade III–IV complications). Operation time > 270 min (p = 0.001) and vital cancer in the resected specimen (p = 0.02) were significantly associated with higher complication rates. Left-sided resection fields involved two-fold higher complication rates, barely missing statistical significance (p = 0.06). Conclusions Pc-RPLND involves a grade III–V complication rate of 14.4%. Prolonged operation time and vital cancer in the residual mass are significantly associated with higher complication rates. The Clavien-Dindo classification system may allow inter-observer variation in rating complication grades, which may represent one reason for the wide range of reported RPLND complication rates. RPLND represents major surgery and surgeons active in this field must be competent to manage adverse events.
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Affiliation(s)
- Christian Guido Ruf
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Germany.,Department of Urology, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Simon Krampe
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Germany
| | - Petra Anheuser
- Department of Urology, Albertinen Krankenhaus Hamburg, Suentelstrasse 11a, 22457, Hamburg, Germany
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Jörg Simon
- Department of Urology, Ortenau-Klinikum, Ebertplatz 12, 77654, Offenburg, Germany
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Klaus Peter Dieckmann
- Department of Urology, Albertinen Krankenhaus Hamburg, Suentelstrasse 11a, 22457, Hamburg, Germany. .,Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany.
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Bakker N, Schoorl M, Demirkiran A, Cense HA, Houdijk AP. Erythrocyte deformability and aggregation in morbidly obese women undergoing laparoscopic gastric bypass surgery and effects of oral omega-3 fatty acid supplementation. Clin Hemorheol Microcirc 2020; 75:303-311. [DOI: 10.3233/ch-190777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: An adequate erythrocyte function is vital for tissue oxygenation and wound healing. The erythrocyte membrane phospholipid composition plays an important role in erythrocyte function and administration of omega-3 fatty acids may provide a means to improve it. OBJECTIVE: To investigate peri-operative erythrocyte function and effects of oral omega-3 fatty acids in morbidly obese women undergoing gastric bypass surgery METHODS: Fifty-six morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery were randomized between a low calorie diet (LCD) during 2 weeks or oral omega-3 poly-unsaturated fatty acids (n-3 PUFAs) and a normal diet during 4 weeks. Peri-operative blood samples were analyzed with the Lorrca MaxSIS Ektacytometer for erythrocyte deformability and aggregability. RESULTS: There were no significant differences in erythrocyte function between the groups at any time point. Only erythrocyte aggregability parameters were affected by surgery. At six month follow-up, aggregation index (AI) and cholesterol, glucose and insulin were significantly improved. CONCLUSIONS: In this study, oral Omega-3 supplementation did not affect erythrocyte function compared to a LCD. Six months after surgery a significant improvement in AI and metabolic parameters was observed in both groups, contributing to a reduction in the risk at thromboembolic and cardiovascular complications.
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Affiliation(s)
- Nathalie Bakker
- Northwest Clinics Alkmaar, Alkmaar, The Netherlands
- Red Cross Hospital Beverwijk, Beverwijk, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Huib A. Cense
- Red Cross Hospital Beverwijk, Beverwijk, The Netherlands
| | - Alexander P.J. Houdijk
- Northwest Clinics Alkmaar, Alkmaar, The Netherlands
- Red Cross Hospital Beverwijk, Beverwijk, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Robert CA, Robert MP, Patel RS. Does Obesity and Procedure Type Increase the Risk of In-Hospital Mortality in Laparoscopic Hysterectomy: A Report From the United States Hospitals. Cureus 2020; 12:e9332. [PMID: 32850207 PMCID: PMC7444856 DOI: 10.7759/cureus.9332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To assess the differences in demographics and laparoscopic hysterectomy type by comorbid obesity and to assess the risk of in-hospital mortality due to obesity and other comorbidities. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2012-2014), and included 119,890 adult females undergoing total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supracervical hysterectomy (LSH). We used a logistic regression model adjusted for confounders to assess the odds ratio (OR) of obesity on mortality in study inpatients. Results The majority of the inpatients were middle-age 36-50 years (83.1%) and White (67.7%). Comorbidities were seen in a higher proportion of obesity cohort with most prevalent being hypertension (53.6%) and diabetes (23.9%), followed by depression and hypothyroidism (15.8% and 15.4%, respectively). Inpatients with comorbid obesity had 4.6 times (95% CI 2.79-7.69) higher odds for in-hospital mortality compared to non-obesity cohort. There was statistically no significant association between type of laparoscopic hysterectomy and in-hospital mortality. Conclusion Analysis of national-level data shows that obese patients have a higher risk of in-hospital mortality by 364% compared to non-obese patients. There was no significant association between the laparoscopy procedure type and in-hospital mortality. More studies should focus on improving hospital outcomes and quality of life post-surgery in obese patients.
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Affiliation(s)
| | - Mary P Robert
- Obstetrics & Gynecology, LLH Hospital, Abu Dhabi, ARE
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Evaluation of Living Kidney Donor and Recipient Candidates: The Experience of Our Center. Transplant Proc 2019; 51:2205-2209. [PMID: 31345596 DOI: 10.1016/j.transproceed.2019.04.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/16/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE We evaluated potential kidney living donors and recipients for donation in our transplant center. MATERIALS AND METHODS Candidates to be kidney living donors and kidney transplant recipients (KTxR) were retrospectively evaluated. All candidates were informed and assessed by transplant coordinator and nephrologists. All data were obtained from archive records. RESULTS The mean ages of 194 kidney living donors and 182 KTxR were 45.7 ± 13.1 and 37.7 ± 14.6 years, respectively. Percentages of female candidates were 55.2% and 34.1% among kidney living donors and KTxR respectively. The kidney living donor candidates were the patients' mothers (27.3%), spouses (24.2%), siblings (21.6%), fathers (12.4%), and sons or daughters (6.2%) of KTxRs and others (8.2%). The numbers of donors with body mass index (BMI) > 30 kg/m2 and > 35kg/m2 were 56 (28.9%) and 17 (8.8%) respectively. Due to withdrawal from donation (21.2%) and renal problems (15.3%), 85/194 (43.8%) kidney living donors were excluded. Of the remaining 51/182 (28%) KTxR candidates, 26/182 (14.2%) were unsuitable because their panel-reactive antibody (PRA) > 20%. Sixty-six KTxR were performed in our center. Nine donor candidates were rejected due to obesity (BMI > 35 kg/m2). CONCLUSION Most of our kidney living donors were mothers, housewives, and uneducated persons. Due to high percentages of suitability among candidates of KTxRs and kidney living donors as 72% and 56% may be an advantage for living kidney donation. However, PRA positivity in the recipients drew attention as a major barrier. The high incidence of obesity among the donor candidates suggests that societies must be more sensitive about this issue.
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Arkenbosch JHC, van Erning FN, Rutten HJ, Zimmerman D, de Wilt JHW, Beijer S. The association between body mass index and postoperative complications, 30-day mortality and long-term survival in Dutch patients with colorectal cancer. Eur J Surg Oncol 2018; 45:160-166. [PMID: 30712552 DOI: 10.1016/j.ejso.2018.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 09/23/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION This retrospective study aims to examine the association between body mass index (BMI) and serious postoperative complications, 30-day mortality and overall survival in colorectal cancer (CRC) patients. MATERIALS AND METHODS All CRC patients diagnosed between 2008 and 2013 in the south-eastern part of the Netherlands were included. Patients were categorized into four BMI groups: underweight (<18.5), normal weight (18.5 ≥ BMI<25), overweight (25 ≥ BMI<30), and obese (≥30). RESULTS A total of 7371 CRC patients were included (underweight 133 (1.8%); normal weight 2054 (41.4%); overweight 2955 (40.1%); obesity 1229 (16.7%)). Underweight patients were more likely to have postoperative complications (18.8% vs. 11.7%, adjusted OR 1.95, 95% CI 1.08-3.49) and had a worse 30-day mortality (9.8% vs. 3.3%, adjusted OR 4.37, 95% CI 2.03-9.42) compared to normal weight patients. After stratification for stage (stage I-III and stage IV), underweight was associated with a worse overall survival in both groups compared to normal weight (stage I-III: HR 2.06, 95%CI 1.51-2.80; stage IV: HR 1.65, 95% CI 1.11-2.45). Overweight was associated with an improved overall survival compared to normal weight in both stage groups. Only in stage IV patients obesity was associated with a significant better overall survival compared to stage IV normal weight patients. CONCLUSION Underweight CRC patients were more likely to have postoperative complications and a worse 30-day mortality compared to patients in other BMI categories. The underweight population also has a worse long-term survival while overweight CRC patients and obese stage IV CRC patients were associated with an improved survival compared to normal weight patients.
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Affiliation(s)
- J H C Arkenbosch
- Division of Surgical Oncology, Radboud University Medical Centre, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - F N van Erning
- Division of Research, Netherlands Comprehensive Cancer Organization (IKNL), Postbus 19079, 3501 DB, Utrecht, the Netherlands; Division of Public Health, Erasmus MC University Medical Centre, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - H J Rutten
- Division of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - D Zimmerman
- Division of Surgery, Elisabeth - TweeSteden Hospital, Doctor Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - J H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - S Beijer
- Division of Research, Netherlands Comprehensive Cancer Organization (IKNL), Postbus 19079, 3501 DB, Utrecht, the Netherlands.
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Sabzi F, Faraji R. Effect of Body Mass Index on Postoperative Complications in Beating Coronary Artery Surgery. Ethiop J Health Sci 2018; 26:509-516. [PMID: 28450765 PMCID: PMC5389069 DOI: 10.4314/ejhs.v26i6.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Body Mass Index (BMI) is considered as an important risk factor in cardiovascular surgery. We designed a historical cohort study for the evaluation of perioperative complications related to BMI in patients who underwent off-pump coronary artery bypass grafting (OPCAB). METHODS We studied 1120 consecutive patients who underwent OPCAB between January 2008 and December 2011 in Imam Ali Hospital, Kermanshah, Iran. Patients were divided into four groups according to BMI: underweight/low BMI (< 18.5 kg/m2), healthy weight (between 18.5 kg/m2 and 24.9 kg/m2), overweight/high BMI (between 25 kg/m2 and 30 kg/m2), and obese/very high BMI (> 30 kg/m2). RESULTS In multivariable regression analysis, an important correlation between the underweight/low BMI group and mortality was observed (p=0.037). Postoperative stroke, postoperative atrial fibrillation (AF) and intra-aortic balloon pump (IABP) use were not associated with BMI. In linear regression analysis, significant correlations between low BMI, reintubation, ICU stay time and intubation time were found. Re-exploration for bleeding was significantly correlated with having a low or high BMI. CONCLUSION Having a low BMI (which is association with malnutrition and respiratory muscles weakness) was significantly associated with reintubation, prolonged intubation time and ICU stay time. The obese group was also associated with postoperative atelectasia and fever.
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Affiliation(s)
- Feridoun Sabzi
- Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Faraji
- Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Sardesai NR, Miller MA, Jauregui JJ, Griffith CK, Henn RF, Nascone JW. Operative management of acetabulum fractures in the obese patient: challenges and solutions. Orthop Res Rev 2017; 9:75-81. [PMID: 30774479 PMCID: PMC6209371 DOI: 10.2147/orr.s113424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In this review, we aim to increase our knowledge of the treatment of acetabular fractures in the obese patient population. The extremely high incidence of obesity in the USA is a looming health care concern that impacts aspects of health care in all medical specialties. There are specific concerns to the orthopedic surgeon when treating obese patients for acetabular fracture. Patients with body mass index ≥30 present particular challenges to the surgeon in terms of preexisting medical conditions, diagnostic imaging, and perioperative complications. Specifically, this patient population experiences worse functional outcomes and greater incidence of surgical site infection, intraoperative blood loss, deep venous thrombosis, post-traumatic osteoarthritis, heterotopic ossification, and increased hospital length of stay. These problems are further exacerbated in the morbidly obese, as a scaling effect exists between increasing body mass index and worsening complication profile. This is problematic given the current high incidence of morbid obesity in the USA and particularly worrisome in light of the projected increase in obesity rates for the future.
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Affiliation(s)
- Neil R Sardesai
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Michael A Miller
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Julio J Jauregui
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Cullen K Griffith
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - R Frank Henn
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Jason W Nascone
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA,
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Henkel DS, Mora-Pinzon M, Remington PL, Jolles SA, Voils CI, Gould JC, Kothari SN, Funk LM. Trends in the Prevalence of Severe Obesity and Bariatric Surgery Access: A State-Level Analysis from 2011 to 2014. J Laparoendosc Adv Surg Tech A 2017; 27:669-675. [DOI: 10.1089/lap.2017.0157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dana S. Henkel
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Maria Mora-Pinzon
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Patrick L Remington
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sally A. Jolles
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Corrine I. Voils
- Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jon C. Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shanu N. Kothari
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Luke M. Funk
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Veterans Affairs Memorial Hospital, Madison, Wisconsin
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Prodromo J, Rackley J, Mulcahey MK. A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery. PHYSICIAN SPORTSMED 2016; 44:231-9. [PMID: 27578242 DOI: 10.1080/00913847.2016.1221750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial.
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Affiliation(s)
- John Prodromo
- a Department of Orthopaedic Surgery , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Justin Rackley
- b Drexel University College of Medicine , Philadelphia , PA , USA
| | - Mary K Mulcahey
- c Department of Orthopaedic Surgery , Hahnemann University Hospital/Drexel University College of Medicine , Philadelphia , PA , USA
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Monn MF, Jaqua KR, Calaway AC, Mellon MJ, Koch MO, Boris RS. Impact of Obesity on Wound Complications Following Radical Prostatectomy Is Mitigated by Robotic Technique. J Endourol 2016; 30:890-5. [DOI: 10.1089/end.2016.0282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- M. Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kaitlin R. Jaqua
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam C. Calaway
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew J. Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael O. Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ronald S. Boris
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Routine Postoperative Monitoring after Bariatric Surgery in Morbidly Obese Patients with Severe Obstructive Sleep Apnea: ICU Admission is not Necessary. Obes Surg 2015. [DOI: 10.1007/s11695-015-1807-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pereira BJ, de Holanda CVM, Ribeiro CA, de Moura SM, de Carvalho Galvão PE, Quidute BSQ, de Oliveira JG. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg 2014; 127:112-5. [DOI: 10.1016/j.clineuro.2014.09.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/01/2014] [Accepted: 09/24/2014] [Indexed: 12/18/2022]
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Pieloch D, Mann R, Dombrovskiy V, DebRoy M, Osband AJ, Mondal Z, Fernandez S, Laskow DA. The Impact of Morbid Obesity on Hospital Length of Stay in Kidney Transplant Recipients. J Ren Nutr 2014; 24:411-6. [DOI: 10.1053/j.jrn.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 01/08/2023] Open
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Jones R, Simorov A, Lomelin D, Tadaki C, Oleynikov D. Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh. Surg Endosc 2014; 29:425-30. [DOI: 10.1007/s00464-014-3690-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/09/2014] [Indexed: 12/18/2022]
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Abstract
Obesity is a medical disease that is increasing significantly nowadays. Worldwide obesity prevalence doubled since 1980. Obese patients are at great risk for complications with physical and psychological burdens, thus affecting their quality of life. Obesity is well known to have higher risk for cardiovascular diseases, diabetes mellitus, musculoskeletal diseases and shorter life expectancy. In addition, obesity has a great impact on surgical diseases, and elective surgeries in comparison to general population. There is higher risk for wound infection, longer operative time, poorer outcome, and others. The higher the BMI (body mass index), the higher the risk for these complications. This literature review illustrates the prevalence of obesity as a diseases and complications of obesity in general as well as, in a surgical point of view, general surgery perioperative risks and complications among obese patients. It will review the evidence-based updates in these headlines.
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Gynecologic Surgery in the Obese Patient. J Minim Invasive Gynecol 2014; 21:155-6. [DOI: 10.1016/j.jmig.2014.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 11/20/2022]
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Zwintscher NP, Horton JD, Steele SR. Obesity has minimal impact on clinical outcomes in children with inflammatory bowel disease. J Pediatr Surg 2014; 49:265-8; discussion 268. [PMID: 24528963 DOI: 10.1016/j.jpedsurg.2013.11.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 11/10/2013] [Indexed: 01/04/2023]
Abstract
PURPOSE Childhood obesity is an increasing problem in affluent societies throughout the world. We sought to identify the impact of obesity on the outcome of inflammatory bowel disease (IBD) and determine differences (if any) between ulcerative colitis (UC) and Crohn's disease (CD). METHODS The 2009 Kids' Inpatient Database was explored for all children (≤ 20 years) admitted with IBD. ICD-9 codes were used to identify obesity and complications, including hemorrhage, perforation, and complex fistulas. Logistic regression analysis accounting for demographics, underlying disease, surgical procedures, and obesity was performed to identify factors associated with complication development. Data are expressed as odds ratios (OR) and a 95% confidence interval (CI). A P value of 0.05 was regarded as significant. RESULTS From 12,465 admissions, 164 children were obese (1.3%), with no difference between CD and UC (1.3% vs. 1.4%; P=0.60). Girls had a two-fold increase in obesity (OR: 2.06, CI: 1.48-2.86; P<0.01). Obesity had no effect on elective/emergent admission rate (OR: 0.85, CI: 0.54-1.35; P=0.49), perforation (OR: 0.76, CI: 0.13-4.46; P=0.76), hemorrhage (OR: 0.64,CI: 0.34-1.21; P=0.17), complex fistula (OR: 1.19, CI: 0.45-3.17; P=0.72), or requirement for surgery (OR: 0.80, CI: 0.48-1.31; P=0.37). While the overall clinical morbidity rate was 10.7%, obesity was not associated with the development of overall complications (OR 1.20, CI: 0.75-1.93; P=0.45) or length of stay (6.36 vs. 6.10 days; P=0.61). Obesity increased the rate of central venous catheter (CVC) infections (OR: 10.98, CI: 2.50-48.20; P<0.01). CONCLUSIONS Obesity was more prevalent in girls with IBD. While obesity did not alter disease severity, rate of surgical intervention, or hospital length of stay, it was associated with higher CVC infections.
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Affiliation(s)
| | - John D Horton
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Scott R Steele
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Abstract
The epidemic of obesity and metabolic syndrome (MS) contributes to the rapid growth of chronic kidney disease (CKD) and end-stage renal disease (ESRD). There is a reverse epidemiology, known as the "obesity paradox," in ESRD patients receiving maintenance dialysis. Obese patients are routinely referred for kidney transplant, and they have more surgical and medical complications than non-obese patients. However, compared to dialysis, kidney transplant provides a survival benefit for obese patients. After kidney transplant, obese patients tend to gain more body weight, and non-obese patients can develop new-onset obesity/MS. Obesity/MS is not only associated with serious morbidities, but also compromises the long-term graft and patient survival. The immunosuppressive drugs commonly used as maintenance therapy, including corticosteroids, calcineurin inhibitors and mammalian target-of-rapamycin inhibitors, contribute to obesity/MS. Development of novel immunosuppressive drugs free of metabolic adverse effects is needed, so that the full potential and benefits of kidney transplantation can be realized.
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De Bruijn KMJ, Arends LR, Hansen BE, Leeflang S, Ruiter R, van Eijck CHJ. Systematic review and meta-analysis of the association between diabetes mellitus and incidence and mortality in breast and colorectal cancer. Br J Surg 2013; 100:1421-9. [PMID: 24037561 DOI: 10.1002/bjs.9229] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Increasing evidence suggests that diabetes mellitus (DM) is associated with increased cancer incidence and mortality. Several mechanisms involved in diabetes, such as promotion of cell proliferation and decreased apoptosis, may foster carcinogenesis. This study investigated the association between DM and cancer incidence and cancer-specific mortality in patients with breast and colorectal carcinoma. METHODS A meta-analysis of controlled trials, prospective cohort studies and pooled cohort studies published after 2007 was conducted. Embase, PubMed and the Cochrane Library were searched. Summary hazard ratios (HRs) were calculated using a random-effects model. Sensitivity and subgroup analyses were performed to adjust for confounders, mode of DM assessment and follow-up time. RESULTS Twenty studies were included to investigate the association between DM and breast and colorectal cancer incidence and cancer-specific mortality. The studies predominantly comprised patients with type II DM. The overall HR for breast cancer incidence was 1·23 (95 per cent confidence interval 1·12 to 1·34) and that for colorectal cancer was 1·26 (1·14 to 1·40) in patients with DM compared with those without diabetes. The overall HR was 1·38 (1·20 to 1·58) for breast cancer- and 1·30 (1·15 to 1·47) for colorectal cancer-specific mortality in patients with DM compared with those without diabetes. CONCLUSION This meta-analysis indicated that DM is a risk factor for breast and colorectal cancer, and for cancer-specific mortality.
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Affiliation(s)
- K M J De Bruijn
- Departments of Surgery, Erasmus MC University Medical Centre, The Netherlands
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The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients. Ann Surg 2013; 258:541-51; discussion 551-3. [PMID: 23979269 DOI: 10.1097/sla.0b013e3182a500ce] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. BACKGROUND Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. METHODS National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. RESULTS Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P < 0.0001) higher per capita cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). CONCLUSIONS Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.
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Bardens D, Solomayer E, Baum S, Radosa J, Gräber S, Rody A, Juhasz-Böss I. The impact of the body mass index (BMI) on laparoscopic hysterectomy for benign disease. Arch Gynecol Obstet 2013; 289:803-7. [DOI: 10.1007/s00404-013-3050-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
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Pieloch D, Dombrovskiy V, Osband AJ, Lebowitz J, Laskow DA. Morbid obesity is not an independent predictor of graft failure or patient mortality after kidney transplantation. J Ren Nutr 2013; 24:50-7. [PMID: 24070588 DOI: 10.1053/j.jrn.2013.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Obesity is often an absolute contraindication to kidney transplant, but an internal analysis of our center's recipients suggests that not all obese populations exhibit poor outcomes. We used national data to compare outcomes in select groups of morbidly obese and normal-weight recipients after kidney transplant. DESIGN This study was a retrospective analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. SUBJECTS The study sample consisted of 30,132 morbidly obese (body mass index [BMI] 35-40 kg/m(2)) and normal-weight (BMI 18.5-24.9 kg/m(2)) patients who underwent primary kidney-only transplantation between 2001 and 2006. MAIN OUTCOME MEASURE Crude 3-year graft and patient survival rates of morbidly obese and normal-weight subgroups were evaluated. Logistic regression modeling compared 3-year graft failure and patient mortality in morbidly obese and normal-weight subgroups with opposite characteristics. Kaplan-Meier survival curves were created for 3-year graft and patient survival. Cox proportional hazard regression modeling was used to determine hazards for patient and graft mortality. RESULTS No differences in crude graft and patient survival rates were seen between normal weight and morbidly obese recipients who were African American, diabetic, and 50 to 80 years of age. Morbidly obese recipients who were nondialysis dependent, nondiabetic, had good functional status, and received living-donor transplants had significantly lower 3-year graft failure and patient mortality risk compared with normal-weight recipients who were dialysis dependent, diabetic, had poor functional status, and received a deceased-donor transplant, respectively (P < .01). Morbidly obese recipients have significantly lower graft and patient survival curves compared with normal-weight recipients; however, multivariate regression analysis reveals that morbid obesity is not an independent predictor of graft failure or patient mortality. CONCLUSIONS Morbid obesity is not independently associated with graft failure or patient mortality; therefore, it should not be used as a contraindication to kidney transplantation.
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Affiliation(s)
- Daniel Pieloch
- The Transplant Center, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
| | - Viktor Dombrovskiy
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Adena J Osband
- The Transplant Center, Robert Wood Johnson University Hospital, New Brunswick, New Jersey; Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jonathan Lebowitz
- The Transplant Center, Robert Wood Johnson University Hospital, New Brunswick, New Jersey; Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David A Laskow
- The Transplant Center, Robert Wood Johnson University Hospital, New Brunswick, New Jersey; Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Michalsky M, Teich S, Rana A, Teeple E, Cook S, Schuster D. Surgical risks and lessons learned: Mortality following gastric bypass in a severely obese adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rosenfeld HE, Limb R, Chan P, Fitzgerald M, Bradley WPL, Rosenfeld JV. Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series. J Neurosurg Spine 2013; 19:101-9. [DOI: 10.3171/2013.4.spine12876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions.
Methods
Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management.
Results
Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues.
Conclusions
Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.
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Affiliation(s)
| | | | | | | | - William Pierre Litherland Bradley
- 4Department of Anaesthesia, The Alfred Hospital and Monash University, Melbourne; and
- 5Department of Surgery, Monash University, Melbourne, Australia
| | - Jeffrey V. Rosenfeld
- 2Department of Neurosurgery, and
- 5Department of Surgery, Monash University, Melbourne, Australia
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Mehasseb MK, Shafi MI. Supra-umbilical vertical midline abdominal incision in morbidly obese gynaecological oncology patients. J OBSTET GYNAECOL 2013; 33:505-7. [DOI: 10.3109/01443615.2013.774325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Morbidities of lung cancer surgery in obese patients. J Thorac Cardiovasc Surg 2013; 146:379-84. [PMID: 23618391 DOI: 10.1016/j.jtcvs.2013.02.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 01/12/2013] [Accepted: 02/11/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is a risk factor for increased perioperative morbidity and mortality in surgical patients. There have been limited studies to correlate the morbidity of lung cancer resection with obesity. METHODS We performed a retrospective study of patients who underwent surgical resection for lung cancer at the Medical College of Wisconsin, Milwaukee, from 2006 to 2010. Data on patient demographics, weight, pathological findings, and hospital course were abstracted after appropriate institutional review board approval. Perioperative morbidity was defined as atrial fibrillation, heart failure, respiratory failure, pulmonary embolism, or any medical complications arising within 30 days after surgery. The Fisher exact test was used to test the association between body mass index (BMI) and perioperative morbidities. RESULTS Between 2006 and 2010, 320 lung resections were performed for lung cancer. The median age was 67 (interquartile range, 59-75) years, and 185 (57.8%) were females. A total of 121 (37.8%) of patients had a BMI lower than 25, and 199 (62.18%) patients had a BMI of 25 or higher. The 30-day mortality rate was 1.8% (n = 6) in the whole group; only 2 of these patients had a BMI of 25 or higher. Perioperative morbidity occurred in 28 (23.14%) of patients with a normal BMI and in 47 (23.61%) of patients with a BMI of 25 or higher (P = .54). Specific morbidities encountered by patients with normal versus BMI of 25 or higher were as follows: atrial fibrillation, 11 (9.09%) versus 24 (12.06%) (P = .46); pulmonary embolism, 1 (0.83%) versus 3 (1.51%) (P = 1.0); congestive heart failure, 2 (1.65%) versus 2 (1.01%) (P = .63); renal failure, 4 (3.3%) versus 2 (1.0%) (P = .29); respiratory failure, 12 (9.92%) versus 17 (8.54%) (P = .69); and acute respiratory distress syndrome, 2 (1.65%) versus 1 (0.50%) (P = .55). The median hospital stay was 5 days in the lower BMI group and 4 days in the BMI of 25 or higher group (P = .52). CONCLUSIONS Overweight and normal weight patients do not differ significantly in rates of perioperative morbidities, 30-day mortality, and length of stay. Our study indicates that potential curative surgical resections can be offered to even significantly overweight patients.
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Lentine KL, Delos Santos R, Axelrod D, Schnitzler MA, Brennan DC, Tuttle-Newhall JE. Obesity and kidney transplant candidates: how big is too big for transplantation? Am J Nephrol 2012; 36:575-86. [PMID: 23221167 DOI: 10.1159/000345476] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/24/2012] [Indexed: 12/11/2022]
Abstract
Obesity impacts many inter-related, and sometimes conflicting, considerations for transplant practice. In this article, we describe an approach for applying available data on the importance of body composition to the kidney transplant population that separates implications for candidate selection, risk stratification among selected candidates, and interventions to optimize health of the individual. Transplant recipients with obesity defined by elevated body mass index (BMI) have been shown in many (but not all) studies to experience an array of adverse outcomes more commonly than normal-weight transplant recipients, including wound infections, delayed graft function, graft failure, cardiac disease, and increased costs. However, current studies have not defined limits of body composition that preclude clinical benefit from transplantation compared with long-term dialysis in patients who have passed a transplant evaluation. Formal cost-effectiveness studies are needed to determine if payers and society should be compensating centers for clinical and financial risks of transplanting obese end-stage renal disease patients. Recent studies also demonstrate the limitations of BMI alone as a measure of adiposity, and further research should be pursued to define practical measures of body composition that refine accuracy for outcomes prediction. Regarding individual management, observational registry studies have not found beneficial associations of pretransplant weight loss with patient or graft survival. However, association studies cannot distinguish purposeful from unintentional weight loss as a result of illness and comorbidity. Prospective evaluations of the impact of targeted risk modification efforts in this population including dietary changes, monitored exercise programs, and bariatric surgery are urgently needed.
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Affiliation(s)
- Krista L Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Abstract
Obesity is a worldwide epidemic leading to severe comorbidity that damages end-organ function. Overall transplant outcomes in this population are inferior to those in nonobese patients. Large population studies show decreased patient and graft survival in obese kidney transplant patients. Despite the poorer outcomes, kidney transplantation is considered because of the survival benefit as compared with the wait-listed dialysis patients. In liver transplantation, the benefit to transplantation as compared with remaining on the list is obvious, as there is no viable liver dialysis at this time. Obesity in potential organ donors impacts both medical and surgical issues. Obesity-related kidney disease affects both the remaining and transplanted kidney. Pancreas donor organs are associated with decreased early graft survival. Liver donor organs with significant steatosis lead to an increased risk for delayed or nonfunction of the organ. Immunosuppressive drugs with variable lipophilicity and altered volume of distribution can greatly affect the therapeutic usefulness of these drugs. Transplant candidates benefit from a multidisciplinary team approach to their care. As the epidemic progresses and less-invasive treatments for metabolic surgery evolve, we are likely to require more patients to lose weight prior to transplantation as we continue to strive for improved outcomes.
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Chin CC, Kuo YH, Yeh CY, Chen JS, Tang R, Changchien CR, Wang JY, Huang WS. Role of body mass index in colon cancer patients in Taiwan. World J Gastroenterol 2012; 18:4191-8. [PMID: 22919253 PMCID: PMC3422801 DOI: 10.3748/wjg.v18.i31.4191] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 04/16/2012] [Accepted: 04/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the effect of body mass index (BMI) on the characteristics and overall outcome of colon cancer in Taiwan.
METHODS: From January 1995 to July 2003, 2138 patients with colon cancer were enrolled in this study. BMI categories (in kg/m2) were established according to the classification of the Department of Health of Taiwan. Postoperative morbidities and mortality, and survival analysis including overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were compared across the BMI categories.
RESULTS: There were 164 (7.7%) underweight (BMI < 18.5 kg/m2), 1109 (51.9%) normal-weight (BMI = 18.5-23.9 kg/m2), 550 (25.7%) overweight (BMI = 24.0-26.9 kg/m2), and 315 (14.7%) obese (BMI ≥ 27 kg/m2) patients. Being female, apparently anemic, hypoalbuminemic, and having body weight loss was more likely among underweight patients than among the other patients (P < 0.001). Underweight patients had higher mortality rate (P = 0.007) and lower OS (P < 0.001) and DFS (P = 0.002) than the other patients. OS and DFS did not differ significantly between normal-weight, overweight, and obese patients, while CSS did not differ significantly with the BMI category.
CONCLUSION: In Taiwan, BMI does not significantly affect colon-CSS. Underweight patients had a higher rate of surgical mortality and a worse OS and DFS than the other patients. Obesity does not predict a worse survival.
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Does Obesity Impact the Success of an InterStim Test Phase for the Treatment of Refractory Urge Urinary Incontinence in Female Patients? Female Pelvic Med Reconstr Surg 2012; 18:243-6. [DOI: 10.1097/spv.0b013e31826150fe] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jones CA, Cox V, Jhangri GS, Suarez-Almazor ME. Delineating the impact of obesity and its relationship on recovery after total joint arthroplasties. Osteoarthritis Cartilage 2012; 20:511-8. [PMID: 22395039 DOI: 10.1016/j.joca.2012.02.637] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/17/2012] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the impact of obesity in predicting short and long-term pain relief and functional recovery in total joint arthroplasty (TJA) either as an independent risk factor or a factor mediated by two chronic conditions associated with obesity-cardiac disease and diabetes mellitus. METHOD A prospective observational study of 520 patients with primary joint arthroplasties. Pain and functional outcomes were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within a month of surgery and then 6 months and 3 years post-operatively. Obesity, cardiac disease and diabetes mellitus were examined as potential risk factors for poor recovery. Patients were classified into four groups based on body mass index (BMI): (normal<25.0 kg/m(2); overweight 25.0-29.9 kg/m(2); obese Class 1 30.0-34.9 kg/m(2); severe obese Class 2&3 35.0 ≥ kg/m(2)). Linear mixed models for each joint type (hip and knee arthroplasty) were developed to examine the pattern of recovery and the effect of obesity. RESULTS Ninety-nine (19%) patients were severely obese, 127 (24%) had cardiac disease and 58 (11%) had diabetes mellitus. Baseline pain and functional scores were similar regardless of BMI classification. Severe obesity was a significant risk factor for worse pain and functional recovery at 6 months but no longer at 3 years following total hip and knee arthroplasty. Cardiac disease predicted a slower recovery after hip arthroplasty. No significant interactions existed between obesity and cardiac disease or diabetes mellitus. DISCUSSION Severe obesity is an independent risk factor for slow recovery over 3 years for both hip and knee arthroplasties.
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Affiliation(s)
- C A Jones
- School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2G4.
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Abstract
BACKGROUND Previous reports comparing outcomes of laparoscopic colectomy in obese vs nonobese patients from small, single-institution series have included few obese patients and have shown variable results, some suggesting that obesity has no impact on outcomes. OBJECTIVE We aimed to determine whether any intraoperative or short-term postoperative outcome of laparoscopic colectomy is affected by obesity, independent of other variables. DESIGN We performed a retrospective study comparing outcomes of patients undergoing laparoscopic colectomy grouped by BMI. PATIENTS We queried American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files for patients undergoing nonemergent, laparoscopic colectomy from 2005 through 2008. Cases with a secondary procedure (with the exception of laparoscopic lysis of adhesions, rigid proctosigmoidoscopy, or laparoscopic splenic flexure takedown) were excluded. MAIN OUTCOME MEASURES We analyzed operative time, length of stay, transfusion requirement, reoperation within 30 days, wound complications, pulmonary complications, sepsis/septic shock, deep venous thrombosis, renal failure/insufficiency, and death. We tested for differences in outcomes using χ tests or analyses of variance, and when differences between BMI classes were found, we performed multivariable regression to adjust for preoperative and intraoperative variables. RESULTS In an analysis of 9693 patients (30% with BMI ≥30), significant differences were found among BMI classes for length of stay, operative time, and wound complication. Operative time correlated with BMI class independent of other variables; length of stay did not. After adjustment of all available variables, obesity remained an independent risk factor for wound complication, and the odds ratios increased with increasing obesity class. LIMITATIONS Retrospective design and standardized outcome measures prevent examination of procedure-specific outcomes; therefore, this is not an intention-to-treat analysis. CONCLUSIONS These data confirm that, in patients undergoing laparoscopic colectomy, obesity is an independent risk factor for wound complications. Although obesity also increases operative time, the effect of obesity on wound complications remains after adjustment for this and other risk factors.
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Jawahar A, Nunley PD. Commentary: advantages of percutaneous pedicle screws in the obese: what is the clinical evidence? Spine J 2011; 11:925-6. [PMID: 22005076 DOI: 10.1016/j.spinee.2011.08.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/30/2011] [Indexed: 02/03/2023]
Affiliation(s)
- Ajay Jawahar
- Spine Institute of Louisiana, 1500 Line Ave., Suite 200, Shreveport, LA 71101, USA.
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Park CY, Kim JC, Kim DY, Kim SK. Inguinal hernia repair in overweight and obese patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:205-10. [PMID: 22066122 PMCID: PMC3204546 DOI: 10.4174/jkss.2011.81.3.205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 06/21/2011] [Accepted: 07/13/2011] [Indexed: 12/03/2022]
Abstract
Purpose To describe the clinical characteristics and outcomes after inguinal hernia repair in overweight and obese patients. Methods We retrospectively reviewed the medical records of 636 adult patients who underwent mesh plug inguinal hernia repair performed by one surgeon from November 2001 to January 2009.The clinical characteristics and surgical outcomes of the patients were analyzed. According to the body mass index, patients higher than 23 were defined as overweight and obese patient group (O group) and patients between 18.5 and 23 were defined as normal weight patient group (N group). Seventeen underweight patients were excluded in this study. Results Of 619 cases, the number for O group was 344 (55.6%) and for N group was 275 (44.4%). The mean age was significantly higher in N group (62.2 ± 12.6 vs. 64.4 ± 14.8, P = 0.048). Underlying diseases were present in 226 (65.7%) of the O group and 191 (69.5%) of the N group (P = 0.322). Anesthesia method, operative time and postoperative hospital stay had no significant difference between the two groups. Postoperative complications developed in 41 (11.9%) of the O group and in 28 (10.2%) of the N group, respectively, and no major complications developed in either group. Conclusion Adult inguinal hernias developed at a relatively younger age in overweight and obese patients than in normal weight patients. There were no specific differences in other clinical characteristics and outcomes between the two groups. Therefore inguinal hernia repair in overweight and obese patients is a safe procedure as in normal weight patients.
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Affiliation(s)
- Chan Yong Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Gettys FK, Russell GV, Karunakar MA. Open treatment of pelvic and acetabular fractures. Orthop Clin North Am 2011; 42:69-83, vi. [PMID: 21095436 DOI: 10.1016/j.ocl.2010.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The open operative management of pelvic and acetabular fractures in the obese is technically demanding, with a significantly higher rate of complications compared with patients who are nonobese. The decision to perform surgery should involve a thorough understanding of risks, and patients should be counseled. Careful attention should be paid to patient factors; coexisting systemic conditions and patient positioning to reduce complications. Wound complications are most commonly seen, and techniques to reduce risk should be incorporated. When complications occur, aggressive management can result in successful salvage. Future areas of study should include methods to reduce risk of surgical site infections and improving our understanding of the physiologic alterations that occur with obesity. This article summarizes the current literature on open treatment of pelvic and acetabular fractures in the obese patient, reviews the physiologic adaptations of obesity as they relate to pelvic surgery, highlights risk factors for complications, and provides recommendations to reduce the incidence of complications.
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Affiliation(s)
- F Keith Gettys
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA
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Does body mass index/morbid obesity influence outcome in patients who undergo pancreatoduodenectomy for pancreatic adenocarcinoma? J Gastrointest Surg 2010; 14:1820-5. [PMID: 20676790 DOI: 10.1007/s11605-010-1285-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/30/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The obesity epidemic coupled with epidemiologic evidence of the link between pancreatic cancer and obesity has raised the interest in the impact of body mass index (BMI) on outcomes for resected pancreatic cancer. METHODS All patients who underwent pancreatoduodenectomy (PD) for pancreatic adenocarcinoma from 1981 to 2007 were categorized into four groups according to their BMI (<25, 25 to <30, 30 to <35, and ≥35). Associations of these BMI groups with perioperative (operating time, blood loss, complications, in-hospital mortality), pathologic (tumor diameter, tumor stage, differentiation, lymph node status, R0 status) features and long-term patient outcome were evaluated using Kruskal-Wallis and chi-square tests, logistic regression, and Cox proportional hazards regression. A second set of analyses were performed by dichotomizing patients into morbidly obese (BMI ≥ 35) in comparison to the rest. RESULTS Of the 586 consecutive patients studied, there were 232 (39.6%) with BMI <25, 232 (39.6%) with BMI 25 to <30, 89 (15.2%) with BMI 30 to <35, and 33 (5.6%) with BMI ≥ 35. Operating time (P = 0.003) and intraoperative blood loss (P < 0.001) increased with BMI, although none of the remaining perioperative features differed significantly among the BMI groups. Similarly, there were no significant associations between BMI group and the pathological features studied, particularly lymph node status (P= 0.98). BMI was not associated with lymph node status even after adjusting for tumor diameter. All analyses were repeated for the morbidly obese. Cox regression did not demonstrate an impact of BMI or morbid obesity on overall or disease-free survival. CONCLUSIONS BMI (and morbid obesity) does not appear to influence long-term outcomes for patients undergoing PD. Surgeons should be vigilant of the greater risk of perioperative blood loss with increasing BMI.
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