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Keshavarzi A, Kardeh S, Dehghankhalili M, Varahram MH, Omidi M, Zardosht M, Mehrabani D. Mortality and Body Mass Index in Burn Patients: Experience from a Tertiary Referral Burn Center in Southern Iran. World J Plast Surg 2019; 8:382-387. [PMID: 31620342 PMCID: PMC6790264 DOI: 10.29252/wjps.8.3.382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The role of obesity has been widely studied as a determinant factor of increasing mortality in surgical patients. In this study we aimed to investigate the association of mortality determinants with obesity classification and BMI score in burn patients admitted to a tertiary referral center in Southern Iran. METHODS In this retrospective cross-sectional study, medical profiles of burn patients admitted from 2016 to 2017 were obtained from Amiralmomenin Burn Hospital, a tertiary referral burn center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Demographic, and clinical characteristics as well as patient outcomes were recorded to determine prognostic factors in fatal burns based on anthropometric measurements. RESULTS Among 101 patients who were enrolled in this study including 73 males and 28 females, mean age was 34.85±12.04 years, total burn surface area (TBSA) was 37.37 (10.50%), BMI was 25.46±5.33 kg/m2 and hospital stay was 22.28±13.62 days. Overall mortality rate was 24.7% with 25 expired cases. Logistic regression demonstrated significant association of older age, male gender, and greater TBSA with mortality. However, difference in mortality rate in patients with BMI of 25 kg/m2 (27.4%) in comparison to patients with BMI<25 kg/m2 (18%) did not reach statistical significance. CONCLUSION Although patients with higher BMI had increased mortality rate following burn injury, this finding showed no significant association. Further studies with larger samples may be necessary to conclude a causal association between BMI and mortality in burn patients.
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Affiliation(s)
- Abdolkhalegh Keshavarzi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Kardeh
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Dehghankhalili
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Varahram
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Omidi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Zardosht
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Mehrabani
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Stem Cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Comparative and Experimental Medicine Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ohman JW, Abuirqeba AA, Jayarajan SN, Balderman J, Thompson RW. Influence of Body Weight on Surgical Treatment for Neurogenic Thoracic Outlet Syndrome. Ann Vasc Surg 2018; 49:80-90. [PMID: 29421422 DOI: 10.1016/j.avsg.2017.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/29/2017] [Accepted: 10/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Body weight affects outcomes of surgical treatment for various conditions, but its effects on the treatment of neurogenic thoracic outlet syndrome (NTOS) are unknown. The purpose of this study was to evaluate the influence of body weight on technical and functional outcomes of surgical treatment for NTOS. METHODS A retrospective review of prospectively collected data was conducted for 265 patients who underwent supraclavicular decompression for NTOS between January 1, 2014 and March 31, 2016. Patients were grouped according to 6 standard body mass index (BMI) categories. The influence of BMI on measures of surgical outcome was analyzed using Pearson correlation statistics, analysis of variance (ANOVA), and multivariate logistic regression. RESULTS Mean patient age was 33.3 ± 0.7 years (range, 12-70), and 208 (78%) patients were women. Mean BMI was 27.2 ± 0.4 (range 16.8-49.9), with 7 underweight (3%), 95 normal (36%), 84 overweight (32%), 47 obese-I (18%), 15 obese-II (6%), and 17 obese-III (6%). There was a slight but significant association between BMI and age (Pearson P < 0.0001, r = 0.264; ANOVA P = 0.0002), but no correlations between BMI and other preoperative variables. There were no differences between BMI groups for intraoperative, immediate postoperative, or 3-month outcomes. Multivariate logistic regression demonstrated that BMI had no significant effect on functional outcome as measured by the extent of improvement in Disability of the Arm, Shoulder, and Hand score at 3 months (P = 0.429). CONCLUSIONS There was no substantive influence of BMI on preoperative characteristics or intraoperative, postoperative, or 3-month outcomes for patients with NTOS, and no indication of an "obesity paradox" for this condition. Supraclavicular decompression for NTOS achieves similar outcomes across the BMI spectrum.
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Affiliation(s)
- J Westley Ohman
- Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ahmmad A Abuirqeba
- Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Senthil N Jayarajan
- Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Joshua Balderman
- Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert W Thompson
- Center for Thoracic Outlet Syndrome, Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
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Harris JA, Byhoff E, Perumalswami CR, Langa KM, Wright AA, Griggs JJ. The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study. Ann Intern Med 2017; 166:381-389. [PMID: 28166546 PMCID: PMC5526224 DOI: 10.7326/m16-0749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown. OBJECTIVE To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life. DESIGN Retrospective cohort. SETTING The HRS (Health and Retirement Study). PARTICIPANTS 5677 community-dwelling Medicare fee-for-service beneficiaries who died between 1998 and 2012. MEASUREMENTS Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. Body mass index was modeled as a continuous variable with a quadratic functional form. RESULTS For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3% (95% CI, 36.5% to 40.2%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3% (CI, 59.4% to 63.2%), and total Medicare expenditures were $42 803 (CI, $41 085 to $44 521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, -9.3 to -4.0 percentage points), hospice duration decreased by 3.8 days (CI, -4.4 to -3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, -6.0 to -0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI ≥40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, -19.6 to -10.9 percentage points), hospice duration decreased by 4.3 days (CI, -5.7 to -2.9 days), and in-home death decreased by 6.3 percentage points (CI, -11.2 to -1.5 percentage points) versus decedents with BMI of 20 kg/m2. LIMITATION Baseline data were self-reported, and the interval between reported BMI and time of death varied. CONCLUSION Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life. PRIMARY FUNDING SOURCE Robert Wood Johnson Foundation Clinical Scholars Program.
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Affiliation(s)
- John A Harris
- From University of Michigan, Ann Arbor, Michigan, and Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Elena Byhoff
- From University of Michigan, Ann Arbor, Michigan, and Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Chithra R Perumalswami
- From University of Michigan, Ann Arbor, Michigan, and Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Kenneth M Langa
- From University of Michigan, Ann Arbor, Michigan, and Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Alexi A Wright
- From University of Michigan, Ann Arbor, Michigan, and Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Jennifer J Griggs
- From University of Michigan, Ann Arbor, Michigan, and Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Grimes MD, Blute ML, Wittmann TA, Mann MA, Zorn K, Downs TM, Shi F, Jarrard DF, Best SL, Richards KA, Nakada SY, Abel EJ. A Critical Analysis of Perioperative Outcomes in Morbidly Obese Patients Following Renal Mass Surgery. Urology 2016; 96:93-98. [PMID: 27339026 DOI: 10.1016/j.urology.2016.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate if body mass index (BMI) ≥ 40 is associated with risk of postoperative complications, receipt of perioperative blood transfusion (PBT), length of hospital stay (LOS), perioperative death, or hospital readmission rate following renal mass surgery. MATERIALS AND METHODS After Institutional Review Board approval, comprehensive information was collected for patients treated with surgery for renal mass from 2000 to 2015 at one institution. Univariable and multivariable analyses were used to evaluate the association of BMI ≥ 40 among other putative risk factors for perioperative outcomes. RESULTS A total of 1048 patients were treated surgically, including 115 (11%) with BMI > 40. Minimally invasive and open surgical approaches were used for 480 (45.8%) and 568 (54.2%) patients, respectively. Morbid obesity was not associated with risk of major complications, overall complications, receipt of PBT, LOS, hospital readmission rate, or perioperative death. Charlson comorbidity index was the only independent predictor of major complications following renal mass surgery, P = .0006, per point odds ratio 1.2 (95%C.I. 1.08-1.32). Surgical site infections (SSIs) were more common in patients with BMI ≥ 40 vs BMI < 40 (10.5% vs 4.8%, P = .01). Following multivariable analysis, BMI ≥ 40 was the only independent predictor of SSIs, odds ratio 2.6, 95% confidence interval 1.32-5.13; P = .006. CONCLUSION Morbid obesity (BMI ≥ 40) is an independent predictor of developing SSIs following renal mass surgery. Morbid obesity is not predictive of risk for major complications, receipt of PBT, hospital readmission, perioperative death, or LOS.
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Affiliation(s)
- Matthew D Grimes
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael L Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tyler A Wittmann
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael A Mann
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kristin Zorn
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tracy M Downs
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fangfang Shi
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David F Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kyle A Richards
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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5
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Blute ML, Zorn K, Grimes M, Shi F, Downs TM, Jarrard DF, Best SL, Richards K, Nakada SY, Abel EJ. Extreme obesity does not predict poor cancer outcomes after surgery for renal cell cancer. BJU Int 2015; 118:399-407. [PMID: 26589741 DOI: 10.1111/bju.13381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess whether extreme obesity (body mass index [BMI] ≥ 40 kg/m(2) ) is associated with peri-operative outcomes, overall survival (OS), cancer-specific survival (CSS), or recurrence-free survival (RFS) after surgical treatment for renal cell carcinoma (RCC). PATIENTS AND METHODS After institutional review board approval, we used an institutional database to identify patients treated surgically between January 2000 and December 2014 with a pathological diagnosis of RCC. Comprehensive clinical and pathological data were reviewed. Kaplan-Meier analyses were used to estimate OS, RFS and CSS. Univariate and multivariate Cox proportional hazards analysis was used to evaluate associations with OS, CSS and RFS in patients with extreme obesity, among other known predictive variables. RESULTS In all, 100 patients (11.9%) with a BMI ≥ 40 kg/m(2) and 743 patients (88.1%) with a BMI < 40 kg/m(2) who were treated surgically for RCC were identified. Morbid obesity was not associated with an increased risk of blood transfusion (odds ratio [OR] 1, 95% confidence interval [CI] 0.587-1.70; P = 1.0). The median (interquartile range) length of hospital stay (LOS) was 4 (3-6) days. Morbid obesity was not associated with longer LOS (P = 0.26) or 30-day hospital readmission rates (P = 1.0). Major complications (Clavien ≥ 3a) were recorded in 67 patients (7.95%). BMI ≥ 40 kg/m(2) was not a predictor of major complications (OR 0.58, 95% CI 0.227-1.47; P = 0.251) or 90-day mortality (P = 0.4067). BMI ≥ 40 kg/m(2) was not associated with worse OS (P = 0.7), CSS (P = 0.2) or RFS (P = 0.5). BMI ≥ 35 kg/m(2) was also not associated with worse OS, CSS or RFS (P = 0.3, 0.1, 0.5, respectively). The 5-year OS rate was 68.9% for the entire cohort, including 69 and 70% for patients with BMI < 40 kg/m(2) and BMI ≥ 40 kg/m(2) , respectively (P = 0.69). The 5-year CSS was 79.5% for the entire cohort, including 78.4 and 87.9% (P = 0.16) for patients with BMI < 40 kg/m(2) and BMI ≥ 40 kg/m(2) , respectively. The 5-year RFS rates for BMI < 40 kg/m(2) and BMI ≥ 40 kg/m(2) were 84.1 and 90.6%, respectively (P = 0.48). CONCLUSIONS Extreme obesity is not associated with worse peri-operative or cancer outcomes after surgery for RCC. Surgery should remain a standard treatment option in well selected morbidly obese patients.
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Affiliation(s)
- Michael L Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristin Zorn
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew Grimes
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fangfang Shi
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tracy M Downs
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David F Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kyle Richards
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Aantaa R, Tonner P, Conti G, Longrois D, Mantz J, Mulier JP. Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development. Multidiscip Respir Med 2015; 10:8. [PMID: 25883785 PMCID: PMC4399437 DOI: 10.1186/s40248-015-0007-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/17/2015] [Indexed: 12/13/2022] Open
Abstract
Background We offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU). Discussion Sedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing is required. Remifentanil is the preferred agent where continuous stable opioid levels using an infusion are required, because of its lack of context-sensitive accumulation. Volatile anaesthetics may be an option for the same reason but there are no substantial, controlled demonstrations of effectiveness/safety in short-term use in the ICU setting. Propofol is a valuable resource in the morbidly obese patients but the duration of continuous sedation should not exceed 6 days, in order to avoid propofol infusion syndrome. Alpha-2 agonists offer a range of theoretically positive features for the sedation of morbidly obese patients, but at present there is a lack of pharmacokinetic data and a critical mass of high-grade clinical data. Dexmedetomidine has the attraction of not causing respiratory depression or obstructive breathing during sedation and its sympatholytic effects should help deliver stable blood pressure and heart rate. Ketamine has a poor tolerability profile in adults so its use in the ICU context is largely confined to paediatrics. Conclusion None of the agents currently available is ideal for every situation encountered in the management of morbidly obese patients. This article identifies additional research needed to place sedation practice of obese patients on a more systematic footing.
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Affiliation(s)
- Riku Aantaa
- Division of Perioperative Services, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Peter Tonner
- Department of Anaesthesiology and Intensive Care Medicine, Emergency Medicine Hospital Links der Weser GmbH, Bremen, Germany
| | - Giorgio Conti
- Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dan Longrois
- Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean Mantz
- Anaesthesiology Department, Beaujon Hospital, AP-HP, Université Paris-Diderot, Paris, France
| | - Jan P Mulier
- Department of Anaesthesiology, Intensive and Emergency Care, Sint Jan Brugge-Oostende, Ruddershove 10, Brugge, 8000 Belgium
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Platz J, Güresir E, Schuss P, Konczalla J, Seifert V, Vatter H. The impact of the body mass index on outcome after subarachnoid hemorrhage: is there an obesity paradox in SAH? A retrospective analysis. Neurosurgery 2014; 73:201-8. [PMID: 23632760 DOI: 10.1227/01.neu.0000430322.17000.82] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity is a risk factor for cardiovascular disease and associated with a poor outcome, especially for intensive care patients. However, recent studies have described favorable outcomes of obese patients after stroke, a phenomenon called the "obesity paradox." OBJECTIVE To assess the impact of the body mass index (BMI) on outcome after subarachnoid hemorrhage (SAH). METHODS We analyzed the data for 741 SAH patients. A BMI greater than 25 kg/m(2) was considered overweight and greater than 30 kg/m(2) obese. The outcome according to the Glasgow Outcome Scale at discharge and after 6 months was assessed using logistic regression analysis. RESULTS According to the BMI, 268 patients (36.2%) were overweight and 113 (15.2%) were obese. A favorable outcome (Glasgow Outcome Scale score >3) was achieved in 53.0% of overweight patients. In contrast, 61.4% of the 360 patients with a normal BMI had a favorable outcome (P = .021). However, in the multivariate analysis, only age (odds ratio [OR]: 1.051, 95% confidence interval [CI]: 1.04-1.07, P < .001), World Federation of Neurological Surgeons grade (OR: 2.095, 95% CI: 1.87-2.35, P < .001), occurrence of vasospasm (OR: 2.90, 95% CI: 1.94-4.34, P < .001), and aneurysm size larger than 12 mm (OR: 2.215, 95% CI: 1.20-4.10, P = .011) were independent predictors of outcome after 6 months. Of the 321 poor grade patients (World Federation of Neurological Surgeons score >3), 171 (53.3%) were overweight. Of these, 21.6% attained a favorable outcome compared with 35.3% of normal-weight patients (P = .006). CONCLUSION Although many physicians anticipate a worse outcome for obese patients, in our study, the BMI was not an independent predictor of outcome. Based on the BMI, obesity seems to be negligible for outcome after SAH compared with the impact of SAH itself, the patient's age, occurrence of vasospasm, or aneurysm size.
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Affiliation(s)
- Johannes Platz
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Does obesity affect outcomes in patients undergoing esophagectomy for cancer? A meta-analysis. World J Surg 2012; 36:1785-95. [PMID: 22526035 DOI: 10.1007/s00268-012-1582-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The incidence of esophageal carcinoma and the global prevalence of obesity are both increasing. As a result, there is an increased number of esophagectomies being performed on obese patients. The identification of specific complications in obese patients undergoing esophagectomy may allow improved risk assessment and postoperative management to reduce morbidity and mortality. This meta-analysis aimed to determine whether obese patients are at increased risk of postoperative complications, mortality, and compromised survival compared to non-obese patients following esophageal resection. METHODS A Medline, Embase, Ovid, and Cochrane database search was performed on all articles between January 1980 and January 2012 comparing post-esophagectomy outcomes between obese and non-obese patients. This study was conducted in accordance with the recommendations of the Cochrane Collaboration and the Quality of Reporting of Meta-Analyses guidelines. RESULTS There was no significant difference between obese and non-obese patients with respect to extent of tumor resection, cardiorespiratory complications, anastomotic leakage, reoperation rates, wound infection, or postoperative mortality. Meta-regression analysis showed that diabetes in obese patients was associated with a significant impact on the risk of anastomotic leakage (coefficient = -7.94 [-15.24-0.65, P = 0.03) and atrial fibrillation (coefficient = -6.94 [-12.79-1.10], P = 0.02). Overall, obese patients had significantly better long-term survival than non-obese patients (Hazard Ratio = 0.78 [0.64-0.96], P = 0.02). CONCLUSIONS In patients who are eligible for surgery, obesity alone does not increase risk of postoperative complications or mortality and should not be an independent contraindication for esophagectomy. However, the presence of diabetes mellitus in conjunction with obesity may be associated with increased risk of anastomotic leakage and atrial fibrillation. Because of the adverse physiological remodeling in obesity, surgeons should maintain a low threshold for the investigation and management of complications and ensure meticulous management of co-morbidities. Obesity may also improve long-term postoperative survival after esophageal surgery, although further studies with higher levels of evidence are necessary to fully determine any advantageous effects of obesity following oncological esophageal surgery.
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Pantenburg B, Sikorski C, Luppa M, Schomerus G, König HH, Werner P, Riedel-Heller SG. Medical students' attitudes towards overweight and obesity. PLoS One 2012; 7:e48113. [PMID: 23144850 PMCID: PMC3489830 DOI: 10.1371/journal.pone.0048113] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/19/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Studies from the USA have identified medical students as a major source of stigmatizing attitudes towards overweight and obese individuals. As data from Europe is scarce, medical students' attitudes were investigated at the University of Leipzig in Leipzig, Germany. DESIGN Cross-sectional survey containing an experimental manipulation consisting of a pair of vignettes depicting an obese and a normal weight 42-year-old woman, respectively. Vignettes were followed by the Fat Phobia Scale (FPS), a semantic differential assessing weight related attitudes. In case of the overweight vignette a panel of questions on causal attribution for the overweight preceded administration of the FPS. SUBJECTS 671 medical students were enrolled at the University of Leipzig from May to June 2011. RESULTS The overweight vignette was rated significantly more negative than the normal weight vignette (mean FPS score 3.65±0.45 versus 2.54±0.38, p<0.001). A higher proportion of students had negative attitudes towards the overweight as compared to the normal weight individual (98.9% versus 53.7%, p<0.001). A "positive energy balance" was perceived as the most relevant cause for the overweight, followed by "negligent personality trait", "societal and social environment" and "biomedical causes". Attributing a "positive energy balance" or "negligent personality trait" as relevant cause for the overweight was positively associated with negative attitudes. CONCLUSION The results of this study confirm and complement findings from other countries, mainly the USA, and indicate that weight bias in the health care setting may be a global issue. Stigmatizing attitudes towards overweight and obesity are prevalent among a sample of medical students at the University of Leipzig. Negative attitudes arise on the basis of holding the individual accountable for the excess weight. They call for bringing the topic of overweight and obesity more into the focus of the medical curriculum and for enhancing medical students' awareness of the complex aetiology of this health condition.
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Affiliation(s)
- Birte Pantenburg
- Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Leipzig, Germany.
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11
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Emergent cricothyroidotomy in the morbidly obese: a safe, no-visualization technique. ACTA ACUST UNITED AC 2012; 71:1873-4. [PMID: 22182897 DOI: 10.1097/ta.0b013e318226fd92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Martindale RG, DeLegge M, McClave S, Monroe C, Smith V, Kiraly L. Nutrition delivery for obese ICU patients: delivery issues, lack of guidelines, and missed opportunities. JPEN J Parenter Enteral Nutr 2012; 35:80S-7S. [PMID: 21881018 DOI: 10.1177/0148607111415532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The most appropriate enteral formula for the severely obese population has yet to be determined. The obese patient in the intensive care unit (ICU) creates numerous difficulties for managing care, one being the ability to deliver appropriate and timely nutrition. Access for nutrition therapy, either enteral or parenteral, can also create a challenge. Currently, no specific guidelines are available on a national or international scale to address the issues of how and when to feed the obese patient in the ICU. A bias against feeding these patients exists, secondary to the perception that an enormous quantity of calories is stored in adipose tissue. Making a specialty enteral formula for obesity from existing commercial formulas and other modular nutrient components is not practical, secondary to difficulty with solubility issues, dilution of the formula, and safety concerns. Using today's concepts and current metabolic data, a formula could be produced that would address many of the specific metabolic derangements noted in obesity. This formula should have a high-protein, low-carbohydrate content with at least a portion of the lipid source coming from fish oil. Specific nutrients that may be beneficial in obesity include arginine, glutamine, leucine, L-carnitine, lipoic acid, S-adenosylmethionine, and betaine. Certain trace minerals such as magnesium, zinc, and selenium may also be of value in the obese population. The concept of a specific bariatric formulation for the ICU setting is theoretically sound, is scientifically based, and could be delivered to patients safely.
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Affiliation(s)
- Robert G Martindale
- Department of Surgery, Oregon Health and Sciences University, Portland, OR 97239, USA.
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Kaafarani HMA, Shikora SA. Nutritional support of the obese and critically ill obese patient. Surg Clin North Am 2011; 91:837-55, viii-ix. [PMID: 21787971 DOI: 10.1016/j.suc.2011.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With the dramatic increase in the prevalence of obesity worldwide and in the United States, it is virtually certain that clinicians will be caring for bariatric and obese nonbariatric patients in increasing numbers. This patient population presents several difficulties from the medical and surgical management perspectives. In particular, nutrition of the bariatric patient and critically ill obese patient is challenging. A clear understanding of the nutritional assessment and unique management strategies available for the bariatric and the critically ill obese patient is essential to provide them with the safest and most effective care.
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Affiliation(s)
- Haytham M A Kaafarani
- Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 437, Boston, MA 02111, USA
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Abstract
Data from the NHS Information Centre reveals that more than one in three adults (36.9%) is overweight. In addition, almost a quarter of adults (24% of men and 25% of women aged 16 or over) are obese, with their need for treatment placing a growing burden on the NHS (The NHS Information Centre 2010). Given these proportions, and that an increasing number of morbidly obese patients are undergoing weight loss surgery and procedures related to obesity, it is an opportune time to review the perioperative care of morbidly obese patients.
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Affiliation(s)
- Sammy Al-Benna
- St Bartholomew's Hospital, West Smithfield, London, ECIA 7BE.
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15
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Abstract
Nearly 20% of all patients admitted to an intensive-care unit are obese. Their excess weight puts them at risk for several problems and complications during their intensive-care unit stay. Especially, pulmonary problems need particular attention, and comprehensive knowledge of the specific pathophysiologic changes of the respiratory system is important. Lung protective ventilation strategies, supplemented by lung-recruiting manoeuvres, may be feasible in critically ill obese patients with lung injury. Careful positioning of the obese is essential to optimise ventilation and facilitate weaning from mechanical ventilation. Optimal hypocaloric nutrition with a high proportion of proteins is advised to control hyperglycaemia. Because mortality in obese patients is similar to or lower than in non-obese ones, it is conceivable that obesity has a protective effect in the critically ill.
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Reid AWN, Gilder FJ, Durrani AJ. Peri-operative safety of the morbidly obese plastic surgical patient: rhabdomyolysis following a modified radical neck dissection. J Plast Reconstr Aesthet Surg 2011; 64:1245-6. [PMID: 21497572 DOI: 10.1016/j.bjps.2011.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/12/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
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