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Yeung E, Smith S, Scharf M, Wung C, Harsha S, Lawson S, Rockwell R, Reitknecht F. BMI disparities in coronary artery bypass grafting outcomes: A single center Society of Thoracic Surgeons (STS) database analysis. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Perioperative outcomes after lower extremity bypass and peripheral vascular interventions in patients with morbid obesity and superobesity. J Vasc Surg 2020; 71:567-574.e4. [DOI: 10.1016/j.jvs.2019.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/04/2019] [Indexed: 11/24/2022]
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3
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Matsumoto R, Fukuda S, Kano M, Suzuki S, Maruno K, Iwahori A, Takahashi S, Kamiya K, Nishibe T, Ogino H. Emergency thromboembolectomy for impending paradoxical embolism through a patent foramen ovale owing to venous thromboembolism in a severely obese patient. Gen Thorac Cardiovasc Surg 2020; 68:1465-1468. [PMID: 31898185 DOI: 10.1007/s11748-019-01283-4] [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: 09/19/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
A severely obese patient with dyspnea and weighing 197 kg presented to us. He experienced an impending paradoxical embolism in the left ventricle caused by a deep vein thrombosis passing through a patent foramen ovale, as well as an acute massive pulmonary thromboembolism. Emergency thromboembolectomy from the right atrium and the bilateral pulmonary arteries was successfully performed. This is an extremely rare case of a severely obese patient with a body mass index of 66.6 kg/m2 who required emergency cardiac surgery by a cardiopulmonary bypass.
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Affiliation(s)
- Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Shoji Fukuda
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan.
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Shun Suzuki
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Keita Maruno
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Akinari Iwahori
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Satoshi Takahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0032, Japan
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Zhang K, Wang J, Yang Y, An R. Adiposity in relation to readmission and all-cause mortality following coronary artery bypass grafting: A systematic review and meta-analysis. Obes Rev 2019; 20:1159-1183. [PMID: 30945439 DOI: 10.1111/obr.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Abstract
This study systemically reviewed evidence linking adiposity to readmission and all-cause mortality in post-coronary artery bypass grafting (CABG) patients. Keyword/reference search was performed in PubMed, Web of Science, CINAHL, and Cochrane Library for articles published before June, 2018. Eligibility criteria included study designs: experimental/observational studies; subjects: adult patients undergoing CABG; and outcomes: hospital/clinic readmissions, and short-term (≤30 days) and mid-to-long-term (>30 days) all-cause mortality. Seventy-two studies were identified. Meta-analysis showed that the odds of post-CABG readmission among patients with overweight was 30% lower than their normal-weight counterparts and the odds of mid-to-long-term post-CABG mortality among patients with overweight were 20% lower than their normal-weight counterparts. In contrast, no difference in post-CABG readmission rate was found between patients with obesity and their nonobese counterparts; no difference in short-term or in-hospital post-CABG mortality rate was found between patients with overweight or obesity and their normal-weight counterparts; and no difference in mid-to-long-term post-CABG mortality rate was found between patients with obesity and their normal-weight counterparts. In conclusion, patients with overweight but not obesity had a lower readmission and mid-to-long-term mortality rate following CABG relative to their normal-weight counterparts. Preoperative weight loss may not be advised to patients with overweight undergoing CABG.
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Affiliation(s)
- Kefeng Zhang
- Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing, Capital Medical University, Beijing, China
| | - Junjie Wang
- Department of Physical Education, Dalian University of Technology, Dalian, Liaoning, China
| | - Yan Yang
- Cabot Microelectronics, Aurora, Illinois, USA
| | - Ruopeng An
- Guangzhou Sport University, Guangzhou, Guangdong, China.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.,Brown School, Washington University, St. Louis, Missouri, USA
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5
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Hales C, Coombs M, de Vries K. The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study. Aust Crit Care 2018; 31:37-41. [DOI: 10.1016/j.aucc.2017.02.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/20/2017] [Accepted: 02/28/2017] [Indexed: 10/19/2022] Open
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De Oliveira GS, McCarthy RJ, Davignon K, Chen H, Panaro H, Cioffi WG. Predictors of 30-Day Pulmonary Complications after Outpatient Surgery: Relative Importance of Body Mass Index Weight Classifications in Risk Assessment. J Am Coll Surg 2017; 225:312-323.e7. [DOI: 10.1016/j.jamcollsurg.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/04/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
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Baimas-George M, Hennings DL, Al-Qurayshi Z, Emad Kandil, DuCoin C. No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery. Surg Obes Relat Dis 2017; 13:1010-1015. [PMID: 28216113 DOI: 10.1016/j.soard.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/18/2016] [Accepted: 12/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. OBJECTIVES To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. SETTING National Inpatient Sample. METHODS We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ2 tests, linear regression analysis, and multivariate logistical regression models. RESULTS A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI<25 kg/m2: odds ratio (OR) 1.01, 95% CI .76-1.34, P = .94; BMI 25 to<35 kg/m2: OR .20, 95% CI .02-2.16, P = .19; BMI≥35 kg/m2: OR>999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMI<25, OR 1.62, 95% CI 1.14-2.30, P = .007). CONCLUSIONS Postoperative bariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery.
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Affiliation(s)
- Maria Baimas-George
- Department of Surgery, Division of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Dietric L Hennings
- Department of Surgery, Division of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Zaid Al-Qurayshi
- Department of Surgery, Division of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Department of Surgery, Division of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Christopher DuCoin
- Department of Surgery, Division of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
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The Effect of Body Mass Index on Surgical Outcomes in Patients Undergoing Pancreatic Resection: A Systematic Review and Meta-Analysis. Pancreas 2016; 45:796-805. [PMID: 27295531 DOI: 10.1097/mpa.0000000000000525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Previous studies that investigated the association between body mass index (BMI) and pancreatectomy outcomes have produced conflicting conclusions. We conducted this meta-analysis to assess the association between them. METHODS We searched PubMed, EMBASE, and Cochrane Library databases up to December 28, 2014. Patients were divided into high-BMI group (BMI ≥ 25 kg/m) and normal-BMI group (BMI < 25 kg/m). Postoperative and intraoperative outcomes were evaluated. Meta-regression and subgroup analysis were performed to evaluate any factors accountable for the heterogeneity. Meta-analysis was performed using a random-effect model. RESULTS We included 22 studies involving 8994 patients. Patients in the high-BMI group had significantly increased postoperative pancreatic fistula rate (odds ratio [OR],1.96; 95% confidence interval [CI], 1.43-2.67), delayed gastric emptying rate (OR, 1.62; 95% CI, 1.15-2.29), wound infection rate (OR, 1.43; 95% CI, 1.07-1.93), operation time (mean difference [MD],15; 95% CI, 13.40-16.60), blood loss (MD, 270.71; 95% CI, 248.93-292.49), and length of hospital stay (MD, 2.87; 95% CI, 1.51-4.24). For modest heterogeneity in postoperative pancreatic fistula, regional distribution tended to be the contributor. CONCLUSIONS High BMI not only increased the surgical difficulty but also decreased the surgical safety for pancreatectomy.
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Terada T, Johnson JA, Norris C, Padwal R, Qiu W, Sharma AM, Janzen W, Forhan M. Severe Obesity Is Associated With Increased Risk of Early Complications and Extended Length of Stay Following Coronary Artery Bypass Grafting Surgery. J Am Heart Assoc 2016; 5:JAHA.116.003282. [PMID: 27250114 PMCID: PMC4937271 DOI: 10.1161/jaha.116.003282] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Better understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and in‐hospital length of stay following coronary artery bypass grafting surgery. Methods and Results We analyzed data from 7560 patients who underwent coronary artery bypass grafting. Using body mass index (BMI; in kg/m2) of 18.5 to 24.9 as a reference, the associations of 4 BMI categories (25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40.0) with rates of operative mortality, overall early complications, subgroups of early complications (ie, infection, renal and pulmonary complications), and length of stay were assessed while adjusting for clinical covariates. There was no difference in operative mortality; however, higher risks of overall complications were observed for patients with BMI 35.0 to 39.9 (adjusted odds ratio 1.35, 95% CI 1.11–1.63) and ≥40.0 (adjusted odds ratio 1.56, 95% CI 1.21–2.01). Subgroup analyses identified obesity as an independent risk factor for infection (BMI 30.0–34.9: adjusted odds ratio 1.60, 95% CI 1.24–2.05; BMI 35.0–39.9: adjusted odds ratio 2.34, 95% CI 1.73–3.17; BMI ≥40.0: adjusted odds ratio 3.29, 95% CI 2.30–4.71). Median length of stay was longer with BMI ≥40.0 than with BMI 18.5 to 24.9 (median 7.0 days [interquartile range 5 to 10] versus 6.0 days [interquartile range 5 to 9], P=0.026). Conclusions BMI ≥40.0 was an independent risk factor for longer length of stay, and infection was a potentially modifiable risk factor. Greater perioperative attention and intervention to control the risks associated with infection and length of stay in patients with BMI ≥40.0 may improve patient care quality and efficiency.
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Affiliation(s)
- Tasuku Terada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen Norris
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, University of Alberta, Edmonton, Alberta, Canada
| | - Raj Padwal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Weiyu Qiu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wonita Janzen
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Passeri LA, Choi JG, Kaban LB, Lahey ET. Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea. J Oral Maxillofac Surg 2016; 74:2033-43. [PMID: 27181624 DOI: 10.1016/j.joms.2016.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. PATIENTS AND METHODS Patients with OSA who underwent maxillomandibular advancement with genial tubercle advancement in the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery from December 2002 to June 2011 were matched to patients with DFD undergoing similar maxillofacial procedures during the same period. They were compared regarding demographic variables, medical comorbidities, perioperative management, intraoperative complications, early and late postoperative complications, and mortality rate. RESULTS A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9 ± 12.5 years vs 21.7 ± 8.6 years), had a higher American Society of Anesthesiologists classification (2.0 ± 0.5 vs 1.3 ± 0.6), and had a higher body mass index (29.6 ± 4.7 kg/m(2) vs 23.0 ± 3.1 kg/m(2)). They also had a greater number of medical comorbidities (2.4 ± 2.3 vs 0.7 ± 1.0). More OSA patients than DFD patients had complications (28 [100%] vs 19 [73%], P = .003), and the total number of complications in the OSA group was higher (108 vs 33, P < .001). Of the complications, 13.9% in the OSA group and 3.0% in the DFD group were classified as major. The absolute risk of a complication was 3.9 for the OSA group versus 1.3 for the DFD group. The relative risk of complications in OSA patients compared with DFD patients was 3.0. No difference in mortality rate was found. CONCLUSIONS The patients in the OSA group were older, had more comorbidities, and ultimately had a greater number of early, late, minor, and major complications than those in the DFD group. The incidence of death in both groups was zero. Maxillomandibular advancement appears to be a safe procedure regarding mortality rate, but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.
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Affiliation(s)
- Luis A Passeri
- Research Fellow and Visiting Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA; and Professor of Oral and Maxillofacial Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - James G Choi
- Resident, Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Leonard B Kaban
- Walter C. Guralnick Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Edward T Lahey
- Assistant in Oral and Maxillofacial Surgery and Instructor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
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Hales C, de Vries K, Coombs M. Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography. Int J Nurs Stud 2016; 58:82-89. [PMID: 27087301 DOI: 10.1016/j.ijnurstu.2016.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/19/2016] [Accepted: 03/23/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. AIM To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. DESIGN AND METHODS A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. SETTING An 18 bedded tertiary intensive care unit in New Zealand. PARTICIPANTS Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). FINDINGS Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. CONCLUSIONS This study has brought new understandings about intensive care situations where social awkwardness occurs in the context of obesity and care practices, and of the performances and behaviours of staff in managing the social awkwardness of fat-stigma during care situations.
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Affiliation(s)
- Caz Hales
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.
| | - Kay de Vries
- Health Sciences, University of Brighton, United Kingdom
| | - Maureen Coombs
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
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Allama A, Ibrahim I, Abdallah A, Ashraf S, Youhana A, Kumar P, Bhatti F, Zaidi A. Effect of body mass index on early clinical outcomes after cardiac surgery. Asian Cardiovasc Thorac Ann 2013; 22:667-73. [DOI: 10.1177/0218492313504092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background there are several reports on the outcomes of cardiac surgery in relation to body mass index. Some concluded that obesity did not increase morbidity or mortality after cardiac surgery, whereas others demonstrated that obesity was a predictor of both morbidity and mortality. Methods this was a retrospective study of 3370 adult patients undergoing cardiac surgery. The patients were divided into 4 groups according to body mass index. The 4 groups were compared in terms of preoperative, operative, and postoperative characteristics. Results obese patients had a significantly younger mean age. Diabetes, hypertension, and hyperlipidemia were significantly more common in obese patients. The crossclamp time was significantly longer in the underweight group. Reoperation for bleeding, and pulmonary, gastrointestinal, and renal complications were significantly more common in the underweight group. Wound complications were significantly more frequent in the obese group. Mortality was inversely proportional to body mass index. The adjusted odds ratios of the early clinical outcomes demonstrated a higher risk of wound complications in overweight and obese patients Conclusion body mass index has no effect on early clinical outcomes after cardiac surgery, except for a higher risk of wound complications in overweight and obese patients.
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Affiliation(s)
- Amr Allama
- Department of Cardiothoracic Surgery, Faculty of Medicine, Menoufia University, Egypt
- Department of Cardiothoracic Surgery, Faculty of Medicine, Taibah University, Kingdom of Saudi Arabia
| | - Islam Ibrahim
- Department of Cardiothoracic Surgery, Faculty of Medicine, Menoufia University, Egypt
| | - Ayat Abdallah
- Department of Public Health and Community Medicine, National Liver Institute, Menoufia University, Egypt
| | - Saeed Ashraf
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Aprim Youhana
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Pankaj Kumar
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Farah Bhatti
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Afzal Zaidi
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
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Grieve E, Fenwick E, Yang HC, Lean M. The disproportionate economic burden associated with severe and complicated obesity: a systematic review. Obes Rev 2013; 14:883-94. [PMID: 23859626 DOI: 10.1111/obr.12059] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 12/16/2022]
Abstract
Burden of disease studies typically classify individuals with a body mass index (BMI) ≥ 30 kg m(-2) as a single group ('obese') and make comparisons to those with lower BMIs. Here, we review the literature on the additional economic burden associated with severe obesity or classes 3 and 4 obesity (BMI ≥ 40 kg m(-2) ), the fastest growing category of obesity, with the aim of exploring and disaggregating differences in resource use as BMI increases beyond 40 kg m(-2) . We recognize the importance of comparing classes 3 and 4 obesity to less severe obesity (classes 1 and 2) as well as quantifying the single sub-class impacts (classes 3 and 4). Although the latter analysis is the aim of this review, we include results, where found in the literature, for movement between the recognized subclasses and within classes 3 and 4 obesity. Articles presenting data on the economic burden associated with severe obesity were identified from a search of Ovid MEDLINE, EMBASE, EBSCO CINAHL and Cochrane Library databases. Data were extracted on the direct costs, productivity costs and resource use associated with severe obesity along with estimates of the multiplier effects associated with increasing BMI. Fifteen studies were identified, of which four disaggregated resource use for BMI ≥ 40 kg m(-2) . The multiplier effects derived for a variety of different types of costs incurred by the severely obese compared with those of normal weight (18.5 kg m(-2) < BMI < 25 kg m(-2) ) ranged from 1.5 to 3.9 for direct costs, and from 1.7 to 8.0 for productivity costs. There are few published data on the economic burden of obesity disaggregated by BMI ≥ 40 kg m(-2) . By grouping people homogenously above a threshold of BMI 40 kg m(-2) , the multiplier effects for those at the highest end of the spectrum are likely to be underestimated. This will, in turn, impact on the estimates of cost-effectiveness for interventions and policies aimed at the severely obese.
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Affiliation(s)
- E Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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15
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Swinkels BM, Vermeulen FEE, Kelder JC, van Boven WJ, Plokker HWM, Ten Berg JM. Predicting 30-day mortality of aortic valve replacement by the AVR score. Neth Heart J 2013; 19:273-8. [PMID: 21494889 DOI: 10.1007/s12471-011-0103-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The objective of this study is to develop a simple risk score to predict 30-day mortality of aortic valve replacement (AVR). METHODS In a development set of 673 consecutive patients who underwent AVR between 1990 and 1993, four independent predictors for 30-day mortality were identified: body mass index (BMI) ≥30, BMI <20, previous coronary artery bypass grafting (CABG) and recent myocardial infarction. Based on these predictors, a 30-day mortality risk score-the AVR score-was developed. The AVR score was validated on a validation set of 673 consecutive patients who underwent AVR almost two decennia later in the same hospital. RESULTS Thirty-day mortality in the development set was ≤2% in the absence of any predictor (class I, low risk), 2-5% in the solitary presence of BMI ≥30 (class II, mild risk), 5-15% in the solitary presence of previous CABG or recent myocardial infarction (class III, moderate risk), and >15% in the solitary presence of BMI <20, or any combination of BMI ≥30, previous CABG or recent myocardial infarction (class IV, high risk). The AVR score correctly predicted 30-day mortality in the validation set: observed 30-day mortality in the validation set was 2.3% in 487 class I patients, 4.4% in 137 class II patients, 13.3% in 30 class III patients and 15.8% in 19 class IV patients. CONCLUSIONS The AVR score is a simple risk score validated to predict 30-day mortality of AVR.
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Affiliation(s)
- B M Swinkels
- Department of Cardiology, St. Antonius Hospital, P.O. Box 2500, 3435 CM, Nieuwegein, the Netherlands,
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Choi JC, Bakaeen FG, Cornwell LD, Dao TK, Coselli JS, LeMaire SA, Chu D. Morbid Obesity Is Associated With Increased Resource Utilization in Coronary Artery Bypass Grafting. Ann Thorac Surg 2012; 94:23-8; discussion 28. [DOI: 10.1016/j.athoracsur.2012.03.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/13/2012] [Accepted: 03/19/2012] [Indexed: 01/22/2023]
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Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL, Matter GJ, Henry AC, Hebeler RF. Effect of body mass index on survival in patients having aortic valve replacement for aortic stenosis with or without concomitant coronary artery bypass grafting. Am J Cardiol 2011; 108:1767-71. [PMID: 21996142 DOI: 10.1016/j.amjcard.2011.09.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2001] [Revised: 09/15/2001] [Accepted: 09/15/2001] [Indexed: 11/16/2022]
Abstract
The purpose of this report is to describe the effect of body mass index (BMI) on 30-day and late outcome in patients having aortic valve replacement (AVR) for aortic stenosis (AS) with or without concomitant coronary artery bypass grafting. From January 2002 through June 2010 (8.5 years), 1,040 operatively excised stenotic aortic valves were submitted to the cardiovascular laboratory at Baylor University Medical Center at Dallas. Of the 1,040 cases 175 were eliminated because they had a previous cardiac operation. The present study included 865 adults whose AVR for AS was their first cardiac operation. Propensity-adjusted analysis showed that 30-day and late mortality were strongly and significantly associated with BMI. Decreased risk of 30-day and long-term mortality was observed for patients with BMI in the low 30s compared to patients with BMI in the mid 20s or >40 kg/m(2). In conclusion, the findings in this study indicate a strong and significant adjusted association between BMI and 30-day and long-term mortality in patients having AVR for AS with or without concomitant coronary artery bypass grafting. Better survival was observed in patients with BMIs in the low 30s compared to patients with BMIs in the mid 20s and >40 kg/m(2).
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Bakaeen FG, Chu D. The obesity paradox and cardiac surgery: are we sending the wrong message? Ann Thorac Surg 2011; 92:1153; author reply 1153-4. [PMID: 21871329 DOI: 10.1016/j.athoracsur.2011.03.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 01/07/2011] [Accepted: 03/11/2011] [Indexed: 11/25/2022]
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Stamou SC, Lobdell KW. Reply. Ann Thorac Surg 2011. [DOI: 10.1016/j.athoracsur.2011.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Westerly BD, Dabbagh O. Morbidity and mortality characteristics of morbidly obese patients admitted to hospital and intensive care units. J Crit Care 2011; 26:180-5. [DOI: 10.1016/j.jcrc.2010.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 12/20/2022]
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Englberger L, Suri RM, Greason KL, Burkhart HM, Sundt TM, Daly RC, Schaff HV. Deep hypothermic circulatory arrest is not a risk factor for acute kidney injury in thoracic aortic surgery. J Thorac Cardiovasc Surg 2011; 141:552-8. [DOI: 10.1016/j.jtcvs.2010.02.045] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 01/28/2010] [Accepted: 02/28/2010] [Indexed: 11/25/2022]
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Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, Marceau P, Franklin BA. Cardiovascular Evaluation and Management of Severely Obese Patients Undergoing Surgery. Circulation 2009; 120:86-95. [DOI: 10.1161/circulationaha.109.192575] [Citation(s) in RCA: 253] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obesity is associated with comorbidities that may lead to disability and death. During the past 20 years, the number of individuals with a body mass index >30, 40, and 50 kg/m
2
, respectively, has doubled, quadrupled, and quintupled in the United States. The risk of developing comorbid conditions rises with increasing body mass index. Possible cardiac symptoms such as exertional dyspnea and lower-extremity edema occur commonly and are nonspecific in obesity. The physical examination and electrocardiogram often underestimate cardiac dysfunction in obese patients. The risk of an adverse perioperative cardiac event in obese patients is related to the nature and severity of their underlying heart disease, associated comorbidities, and the type of surgery. Severe obesity has not been associated with increased mortality in patients undergoing cardiac surgery but has been associated with an increased length of hospital stay and with a greater likelihood of renal failure and prolonged assisted ventilation. Comorbidities that influence the preoperative cardiac risk assessment of severely obese patients include the presence of atherosclerotic cardiovascular disease, heart failure, systemic hypertension, pulmonary hypertension related to sleep apnea and hypoventilation, cardiac arrhythmias (primarily atrial fibrillation), and deep vein thrombosis. When preoperatively evaluating risk for surgery, the clinician should consider age, gender, cardiorespiratory fitness, electrolyte disorders, and heart failure as independent predictors for surgical morbidity and mortality. An obesity surgery mortality score for gastric bypass has also been proposed. Given the high prevalence of severely obese patients, this scientific advisory was developed to provide cardiologists, surgeons, anesthesiologists, and other healthcare professionals with recommendations for the preoperative cardiovascular evaluation, intraoperative and perioperative management, and postoperative cardiovascular care of this increasingly prevalent patient population.
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Short-term and long-term outcome in low body mass index patients undergoing cardiac surgery. Gen Thorac Cardiovasc Surg 2009; 57:87-93. [DOI: 10.1007/s11748-008-0336-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
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Molnar J, Colah S, Larobina M, Large SR, Arrowsmith JE, Klein AA. Cardiopulmonary bypass and deep hypothermic circulatory arrest in a massively obese patient. Perfusion 2009; 23:243-5. [PMID: 19181758 DOI: 10.1177/0267659108099790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As a consequence of the rising global prevalence and magnitude of obesity, a greater proportion of patients presenting for cardiac surgery is morbidly obese. Being overweight (body mass index; BMI 25-29.9 kg/m(2)) or obese (BMI 30-35 kg/m(2)) appears to confer some survival benefit following cardiac surgery. By contrast, morbid obesity (BMI >40 kg/m(2)) is associated with an increased likelihood of postoperative complications and prolonged intensive care unit and hospital length of stay. The physical difficulties encountered when managing this group of patients is exemplified by those undergoing complex, multiple procedures requiring prolonged cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). We present the successful management of a massively obese 19-year-old male (BMI 45 kg/m(2)) with Marfan's syndrome who required aortic root and arch replacement under DHCA. The selection of extracorporeal circuit components to accommodate a large circulating volume and permit high CPB flow rates (>9 l/min) is discussed.
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Affiliation(s)
- J Molnar
- Department of Anaesthesia, Papworth Hospital, Cambridge, United Kingdom
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Cavarocchi NC. Invited Commentary. Ann Thorac Surg 2009; 87:546-7. [DOI: 10.1016/j.athoracsur.2008.11.012] [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: 11/05/2008] [Revised: 11/05/2008] [Accepted: 11/10/2008] [Indexed: 11/26/2022]
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Sun X, Hill PC, Bafi AS, Garcia JM, Haile E, Corso PJ, Boyce SW. Is Cardiac Surgery Safe in Extremely Obese Patients (Body Mass Index 50 or Greater)? Ann Thorac Surg 2009; 87:540-6. [DOI: 10.1016/j.athoracsur.2008.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 10/06/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
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Williams TK, Rosato EL, Kennedy EP, Chojnacki KA, Andrel J, Hyslop T, Doria C, Sauter PK, Bloom J, Yeo CJ, Berger AC. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 2008; 208:210-7. [PMID: 19228532 DOI: 10.1016/j.jamcollsurg.2008.10.019] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 10/08/2008] [Accepted: 10/08/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity has been implicated as a risk factor for perioperative and postoperative complications. The aim of this study was to determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD). STUDY DESIGN Between January 2000 and July 2007, 262 patients underwent PD at Thomas Jefferson University Hospital, of whom 240 had complete data, including body mass index (BMI; calculated as kg/m(2)) for analysis. Data on BMI, preoperative parameters, operative details, and postoperative course were collected. Patients were categorized as obese (BMI >or= 30), overweight (BMI >or= 25 and < 30), or normal weight (BMI < 25). Complications were graded according to previously published scales. Other end points included length of postoperative hospital stay, blood loss, and operative duration. Analyses were performed using univariate and multivariable models. RESULTS There were 103 (42.9%) normal-weight, 71 (29.6%) overweight, and 66 (27.5%) obese patients. There were 5 perioperative deaths (2.1%), with no differences across BMI categories. A significant difference in median operative duration and blood loss between obese and normal-weight patients was identified (439 versus 362.5 minutes, p = 0.0004; 650 versus 500 mL, p = 0.0139). In addition, median length of stay was significantly longer for BMI (9.5 versus 8 days, p = 0.095). Although there were no significant differences in superficial wound infections, obese patients did have an increased rate of serious complications compared with normal-weight patients (24.2% versus 13.6%, respectively; p = 0.10). CONCLUSIONS Obese patients undergoing PD have a substantially increased blood loss and longer operative time but do not have a substantially increased length of postoperative hospital stay or rate of serious complications. These findings should be considered when assessing patients for operation and when counseling patients about operative risk, but they do not preclude obese individuals from undergoing definitive pancreatic operations.
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Affiliation(s)
- Timothy K Williams
- Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Disease Center, Philadelphia, PA 19107, USA
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House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M, Gonen M, Olson SH, Kurtz RC, Brennan MF, Allen PJ. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008; 12:270-8. [PMID: 18060467 DOI: 10.1007/s11605-007-0421-7] [Citation(s) in RCA: 211] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 11/05/2007] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to examine the preoperative patient and radiographic factors that are associated with operative morbidity after pancreaticoduodenectomy. MATERIAL AND METHODS Patient characteristics and preoperative radiographic findings and their association with postoperative complications after pancreaticoduodenectomy were analyzed for 356 patients with pancreatic adenocarcinoma who underwent resection between 2000 and 2005. RESULTS Postoperative complications developed in 135 patients (38%). The most common complications were pancreatic fistula/abscess (15%), wound infection (14%), and delayed gastric emptying (4%). On multivariate analysis, the only preoperative radiographic factors associated with having any postoperative complication were the absence of pancreatic atrophy and the extent of central obesity determined by the thickness of retrorenal visceral fat (VF). Complications occurred in 51% of patients with VF > or = 2 cm, compared to 31% of patients with VF < 2 cm, p < 0.001. Postoperatively, pancreatic fistula developed in 24% of patients with VF > or = 2 cm and in only 10% of patients with VF < 2 cm, p = 0.01. Wound infections occurred in 21% of the patients with body mass index greater than or equal to 30 kg/m(2) compared to 12% of the nonobese patients, p = 0.03. CONCLUSIONS Generalized obesity is associated with postoperative wound infections after pancreaticoduodenectomy. The degree of visceral fat on preoperative cross-sectional imaging is associated with significantly higher rates of overall complications and pancreatic fistula.
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Affiliation(s)
- Michael G House
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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