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Douglas ME, Mamawala M, Brown S, Powers MB, Warren AM. Associations of mood symptoms and body mass among individuals with COVID-19. Proc AMIA Symp 2024; 37:755-762. [PMID: 39165826 PMCID: PMC11332635 DOI: 10.1080/08998280.2024.2358294] [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: 11/30/2023] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction The COVID-19 pandemic has had a significant impact on mental health, and individuals with certain preexisting morbidities-such as obesity-may have disproportionately experienced pandemic-related stress. We aimed to examine whether being obese or overweight was associated with worse mood and trauma among those infected with COVID-19. Methods Data were collected as part of a larger longitudinal survey study (n = 591) examining the psychological impact of COVID-19. Complete baseline data for those who reported testing positive from April 2020 through June 2021 were examined. Results and conclusions Body mass index was correlated with depression (r = 0.13, P < .01) and generalized anxiety disorder (r = 0.10, P = .02), but not with posttraumatic stress disorder (r = 0.06, P = .16). Multivariable analyses revealed that body mass index was no longer a unique predictor, except for those with a body mass index >40 kg/m2, suggesting that other sociodemographic factors, not obesity, were driving mood symptoms for those infected with COVID-19.
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Affiliation(s)
| | | | - Shakeira Brown
- Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Mark B. Powers
- Baylor Scott & White Research Institute, Dallas, Texas, USA
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Ansari SA, Suheb MZ, Rashid M, Maqsood MH, Rashid AM, Javaid SS, Siddiqi AK. Impact of Body Mass Index on outcomes in hospitalized heart failure patients with reduced versus preserved ejection fraction: a 1,699,494-individual analysis from the United States National Inpatient Sample. Minerva Cardiol Angiol 2024; 72:141-151. [PMID: 37800451 DOI: 10.23736/s2724-5683.23.06367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Obesity's effect on outcomes in heart failure (HF) patients with reduced versus maintained ejection fraction (HFrEF and HFpEF) remains debatable. We evaluated hospital outcomes and healthcare expenditures in these patients based on their Body Mass Index (BMI). METHODS Using the USA National Inpatient Sample (NIS) database, patients >18 years admitted with a primary diagnosis of HFrEF or HFpEF between January 1, 2004, and August 31, 2015, were studied. Patients were stratified into the following BMI categories: underweight, normal weight, overweight, obese, and morbidly obese. Adjusted multivariable analyses using Poisson regression models were used to study the association between BMI and hospital outcomes and healthcare costs. RESULTS Overall, 1,699,494 patients were included. After full adjustment, obesity (OR=1.84; 95% CI: 1.22-2.76) and morbid obesity (OR=1.81; 95% CI: 1.22-2.70) increased the odds of in-hospital mortality compared with normal weight. When stratified per ejection fraction, underweight patients had higher odds of in-hospital mortality in HFrEF (OR=1.46; 95% CI: 1.06-2.01). Obese and morbidly obese patients had higher odds of in-hospital mortality in both HFrEF and HFpEF. Furthermore, obese and morbidly obese patients had a longer mean adjusted length of stay and higher health care expenses. CONCLUSIONS Being underweight is associated with increased risk of in-hospital mortality in HFrEF patients. Obesity and morbid obesity increase the risk of in-hospital mortality and higher healthcare costs in both HFrEF and HFpEF. These findings have clinical significance for HF patients, and further research is needed to investigate the ideal weight for HF patients.
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Affiliation(s)
- Saad A Ansari
- Riverside School of Medicine, University of California, Riverside, CA, USA
| | | | - Muhammad Rashid
- Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | | | - Ahmed M Rashid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan -
| | - Syed S Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Ahmed K Siddiqi
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
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Sagah GA, Fayed MM. Body mass index as a predictor of the outcomes of acute clozapine toxicity: a cross-sectional study. Toxicol Res (Camb) 2023; 12:599-607. [PMID: 37663813 PMCID: PMC10470374 DOI: 10.1093/toxres/tfad051] [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: 12/16/2022] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023] Open
Abstract
Acute antipsychotic overdose is frequently reported nowadays. Clozapine is one of the atypical agents that are highly lipophilic, highly protein-bound, has a large volume of distribution, and accumulates in the brain and other tissues. Obesity is an essential factor controlling patients' treatment and clinical course. The current study aimed to study the prognostic value of body mass index (BMI) in patients with acute clozapine poisoning. All patients were evaluated on admission using the Poison Severity Score (PSS) and Glasgow Coma Score (GCS). The BMI was calculated. Mortality and the need for ICU admission were defined as primary outcomes, whereas secondary outcomes included cardiovascular complications and the need for mechanical ventilation. Thirty-eight patients presented with acute clozapine poisoning. The mean age of included patients was 25.2 ± 6. Patients were categorized regarding BMI into average weight (26.3%), overweight (31.6%), and obese (42.1%). Pearson's correlation indicated a significant positive correlation between BMI and respiratory rate (r = .364, p = .025). A significant negative correlation existed between BMI and GCS (r = .674, p ≤ .001). ROC curve reveals that BMI is an excellent predictor for the requirement of mechanical ventilation area under the curve (AUC > .9), a fair predictor of ICU admission AUC (.747). BMI had a sensitivity of 100% and specificity of 51.7 for the prediction of ICU admission. In conclusion, obesity increased the severity of toxicity and the incidence of poor clinical outcomes in patients with acute clozapine poisoning.
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Affiliation(s)
- Ghada A Sagah
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Manar M Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
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Zalikha AK, Abbas KAJ, Karabon P, Hussein IH, El-Othmani MM. The Impact of Month on Joint Arthroplasty In-Hospital Outcomes: The December Effect. Arthroplast Today 2022; 16:101-106. [PMID: 35669461 PMCID: PMC9162911 DOI: 10.1016/j.artd.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 10/27/2022] Open
Abstract
Background The purpose of this study was to assess the impact of month of the year on postsurgical outcomes after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to specifically analyze for a December effect. Material and methods The National Inpatient Sample was used to identify all patients older than 40 years undergoing primary TKA and THA between 2006 and 2015. Patients were stratified based on the month of the year of surgery. In-hospital complication, disposition, and economic outcomes were comparatively analyzed. Results There were statistically significant differences in outcomes based on month of the year. When comparing December to the other months, both TKA and THA patients had significantly lower rates of any complication, postoperative anemia, and genitourinary complications, while there were significantly higher rates of home than rehab discharge and shorter average length of stay in December. THA patients additionally had significantly lower rates of cardiac and respiratory complications during December. Conclusion Postoperative outcomes are significantly associated with the month in which arthroplasty is performed. This study provides evidence of a positive "December effect" of improved in-hospital complications and economic outcomes for surgeries performed in December. Future research should direct attention to the impact that social factors may have on outcomes after elective surgical procedures and how these factors may be translated to other months.
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Affiliation(s)
- Abdul Kareem Zalikha
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Kassem-Ali J Abbas
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Patrick Karabon
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Inaya Hajj Hussein
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Mouhanad M El-Othmani
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, USA
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Hussein IH, Zalikha AK, Tuluca A, Crespi Z, El-Othmani MM. Epidemiology of Obese Patients Undergoing Revision Total Knee Arthroplasty: Understanding Demographics, Comorbidities, and Propensity Weighted Analysis of Inpatient Outcomes. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00263. [PMID: 35171855 PMCID: PMC8853623 DOI: 10.5435/jaaosglobal-d-21-00263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Obesity is a public health epidemic that is projected to grow in coming years. Observational data on the epidemiologic profile and immediate postoperative outcomes of obesity and morbid obesity after revision total knee arthroplasty (rTKA) are limited. METHODS Discharge data from the National Inpatient Sample was used to identify patients who underwent rTKA from 2006 to 2015. Patients were stratified into morbidly obese, obese, and not obese control cohorts. An analysis was performed to compare etiology of revision, demographic and medical comorbidity profiles, and immediate in-hospital economic and complication outcomes after rTKA. RESULTS An estimated 605,603 rTKAs were included in this analysis. Morbidly obese and obese patients were at significantly higher risk for any complication than not obese patients. Patients with obesity were associated with an increased risk of postoperative anemia but a lower risk of peripheral vascular disease and gastrointestinal, and hematoma/seroma complications compared with not obese patients. Patients with morbid obesity were associated with an increased risk of any, hematoma/seroma, wound dehiscence, postoperative infection, pulmonary embolism, and postoperative anemia complications and a lower risk of gastrointestinal complications when compared with not obese patients. Morbidly obese patients had a significantly longer length of stay than both obese and not obese patients, while no significant difference in length of stay was observed between obese and not obese patients. DISCUSSION Morbidly obese patients are at higher odds for worse postoperative medical and economic outcomes compared with those with obesity after rTKA. As the number of patients with obesity and morbid obesity continues to rise, these risk factors should be considered in preoperative discussions and perioperative protocol optimization.
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Soffer S, Zimlichman E, Glicksberg BS, Efros O, Levin MA, Freeman R, Reich DL, Klang E. Obesity as a mortality risk factor in the medical ward: a case control study. BMC Endocr Disord 2022; 22:13. [PMID: 34991575 PMCID: PMC8733434 DOI: 10.1186/s12902-021-00912-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Research regarding the association between severe obesity and in-hospital mortality is inconsistent. We evaluated the impact of body mass index (BMI) levels on mortality in the medical wards. The analysis was performed separately before and during the COVID-19 pandemic. METHODS We retrospectively retrieved data of adult patients admitted to the medical wards at the Mount Sinai Health System in New York City. The study was conducted between January 1, 2011, to March 23, 2021. Patients were divided into two sub-cohorts: pre-COVID-19 and during-COVID-19. Patients were then clustered into groups based on BMI ranges. A multivariate logistic regression analysis compared the mortality rate among the BMI groups, before and during the pandemic. RESULTS Overall, 179,288 patients were admitted to the medical wards and had a recorded BMI measurement. 149,098 were admitted before the COVID-19 pandemic and 30,190 during the pandemic. Pre-pandemic, multivariate analysis showed a "J curve" between BMI and mortality. Severe obesity (BMI > 40) had an aOR of 0.8 (95% CI:0.7-1.0, p = 0.018) compared to the normal BMI group. In contrast, during the pandemic, the analysis showed a "U curve" between BMI and mortality. Severe obesity had an aOR of 1.7 (95% CI:1.3-2.4, p < 0.001) compared to the normal BMI group. CONCLUSIONS Medical ward patients with severe obesity have a lower risk for mortality compared to patients with normal BMI. However, this does not apply during COVID-19, where obesity was a leading risk factor for mortality in the medical wards. It is important for the internal medicine physician to understand the intricacies of the association between obesity and medical ward mortality.
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Affiliation(s)
- Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel.
- Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Eyal Zimlichman
- Hospital Management, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
| | - Benjamin S Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Orly Efros
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Thrombosis & Hemostasis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Matthew A Levin
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert Freeman
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - David L Reich
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eyal Klang
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
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Dilrukshi MDSA, Thotamuna V, Senarath Yapa DJ, De Silva L, Ranasinghe P, Katulanda P. Influence of Overweight and Obesity on Morbidity and Mortality among Hospitalized Patients in Sri Lanka: A Single-Center Analysis. J Obes 2022; 2022:9172365. [PMID: 36033432 PMCID: PMC9411002 DOI: 10.1155/2022/9172365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Current evidence regarding the association between overweight and obesity and in-hospital morbidity and mortality is inconsistent and South Asian populations are underrepresented. METHODS Data relevant to anthropometry, hospital outcomes, complications, and medical diagnoses of all acute medical admissions to the National Hospital of Sri Lanka were collected over a period of 3 months. Analysis was performed with WHO international (ICs) and Asian obesity cut-offs (ACs). RESULTS Sample size was 2,128 (median age: 57 years [IQR: 42, 67], males: 49.7%). High prevalence of overweight (23.5%), generalized obesity (10.4%), central obesity (28.5%), and underweight (15.4%) was observed (ICs). Patients with either generalized or central obesity had significantly higher in-hospital mortality (4.8% versus 2.5%, p = 0.031) and acute kidney injury (AKI) (3.9% versus 1.2%) (p = 0.001) compared to normal weight. With ACs, overweight and obesity prevalence increased, without any significant increment in morbidity and mortality, but median length of hospital stay was significantly reduced in patients with generalized obesity compared to normal (3 [IQR: 2, 5] versus 4 [IQR: 2, 6], p = 0.014). Infections (44.4%) and cardiovascular diseases (CVDs) (25.9%) were the most common causes of admission. Overweight and generalized obesity or central obesity were associated with increased prevalence of acute CVDs and CVD risk factors and lower prevalence of acute infections, whilst underweight showed an inverse association. CONCLUSION A double burden of malnutrition and diseases were noted among hospital admissions, with obesity being a risk factor for in-hospital all-cause mortality and AKI. Overweight and obesity were associated with increased CVDs and reduced infections. Larger prospective studies are required to characterize these associations among South Asians.
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Affiliation(s)
| | - V. Thotamuna
- Diabetes Trial Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - D. J. Senarath Yapa
- Diabetes Trial Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - L. De Silva
- Diabetes Trial Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - P. Ranasinghe
- National Hospital of Sri Lanka, Colombo, Sri Lanka
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - P. Katulanda
- National Hospital of Sri Lanka, Colombo, Sri Lanka
- Diabetes Trial Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Patlolla SH, Ya’Qoub L, Prasitlumkum N, Sundaragiri PR, Cheungpasitporn W, Doshi RP, Rab ST, Vallabhajosyula S. Trends and differences in management and outcomes of cardiac arrest in underweight and obese acute myocardial infarction hospitalizations. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:576-586. [PMID: 34849289 PMCID: PMC8611264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
The influence of weight on in-hospital events of acute myocardial infarction complicated with cardiac arrest (AMI-CA) is understudied. To address this, we utilized the National Inpatient Sample database (2008-2017) to identify adult AMI-CA admissions and categorized them by BMI into underweight, normal weight, and overweight/obese groups. The outcomes of interest included differences in in-hospital mortality, use of invasive therapies, hospitalization costs, and hospital length of stay across the three weight categories. Of the 314,609 AMI-CA admissions during the study period, 268,764 (85.4%) were normal weight, 1,791 (0.6%) were underweight, and 44,053 (14.0%) were overweight/obese. Compared to 2008, in 2017, adjusted temporal trends revealed significant increase in prevalence of AMI-CA in underweight (adjusted OR {aOR} 3.88 [95% CI 3.04-4.94], P<0.001) category, and overweight/obese AMI-CA admissions (aOR 2.67 [95% CI 2.53-2.81], P<0.001). AMI-CA admissions that were underweight were older, more often female, with greater comorbidity burden, and presented more often with non-ST-segment-elevation AMI, non-shockable rhythm, and in-hospital arrest. Overweight/obesity was associated with higher use of angiography, PCI, and greater need for mechanical circulatory support whereas underweight status had the lowest use of these procedures. Compared to normal weight AMI-CA admissions, underweight admissions had comparable adjusted in-hospital mortality (adjusted OR 0.97 [95% CI 0.87-1.09], P=0.64) whereas overweight/obese admissions had lower in-hospital mortality (adjusted OR 0.92 [95% CI 0.90-0.95], P<0.001). In conclusion, underweight AMI-CA admissions were associated with lower use of cardiac procedures and had in-hospital mortality comparable to normal weight admissions. Overweight/obese status was associated with higher rates of cardiac procedures and lower in-hospital mortality.
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Affiliation(s)
| | - Lina Ya’Qoub
- Division of Cardiovascular Medicine, Department of Medicine, Louisiana State University Health Science CenterShreveport, Louisiana, USA
| | - Narut Prasitlumkum
- Division of Cardiology, University of California RiversideRiverside, California, USA
| | - Pranathi R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health WestwoodHigh Point, North Carolina, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo ClinicRochester, Minnesota, USA
| | - Rajkumar P Doshi
- Department of Medicine, University of Nevada Reno School of MedicineReno, Nevada, USA
| | - Syed Tanveer Rab
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of MedicineHigh Point, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of MedicineHigh Point, North Carolina, USA
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The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study. J Clin Med 2021; 10:jcm10194382. [PMID: 34640400 PMCID: PMC8509550 DOI: 10.3390/jcm10194382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18-79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5-29.9 kg/m2), obese (BMI 30-39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02-1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11-1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.
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Patlolla SH, Gurumurthy G, Sundaragiri PR, Cheungpasitporn W, Vallabhajosyula S. Body Mass Index and In-Hospital Management and Outcomes of Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 57:medicina57090926. [PMID: 34577849 PMCID: PMC8464976 DOI: 10.3390/medicina57090926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Contemporary data on the prevalence, management and outcomes of acute myocardial infarction (AMI) in relation to body mass index (BMI) are limited. Materials and Methods: Using the National Inpatient Sample from 2008 through 2017, we identified adult AMI hospitalizations and categorized them into underweight (BMI < 19.9 kg/m2), normal BMI and overweight/obese (BMI > 24.9 kg/m2) groups. We evaluated in-hospital mortality, utilization of cardiac procedures and resource utilization among these groups. Results: Among 6,089,979 admissions for AMI, 38,070 (0.6%) were underweight, 5,094,721 (83.7%) had normal BMI, and 957,188 (15.7%) were overweight or obese. Over the study period, an increase in the prevalence of AMI was observed in underweight and overweight/obese admissions. Underweight AMI admissions were, on average, older, with higher comorbidity, whereas overweight/obese admissions were younger and had lower comorbidity. In comparison to the normal BMI and overweight/obese categories, significantly lower use of coronary angiography (62.3% vs. 74.6% vs. 37.9%) and PCI (40.8% vs. 47.7% vs. 19.6%) was observed in underweight admissions (all p < 0.001). The underweight category was associated with significantly higher in-hospital mortality (10.0% vs. 5.5%; OR 1.23 (95% CI 1.18–1.27), p < 0.001), whereas being overweight/obese was associated with significantly lower in-hospital mortality compared to normal BMI admissions (3.1% vs. 5.5%; OR 0.73 (95% CI 0.72–0.74), p < 0.001). Underweight AMI admissions had longer lengths of in-hospital stay with frequent discharges to skilled nursing facilities, while overweight/obese admissions had higher hospitalization costs. Conclusions: In-hospital management and outcomes of AMI vary by BMI. Underweight status was associated with worse outcomes, whereas the obesity paradox was apparent, with better outcomes for overweight/obese admissions.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Gayathri Gurumurthy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Pranathi R. Sundaragiri
- Primary Care Internal Medicine, Wake Forest Baptist Health Westwood, High Point, NC 27262, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, High Point, NC 27262, USA
- Correspondence: ; Tel.: +1-(336)-878-6000
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Chen B, Yo CH, Patel R, Liu B, Su KY, Hsu WT, Lee CC. Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: A national cohort study. United European Gastroenterol J 2021; 9:561-570. [PMID: 33951338 PMCID: PMC8259364 DOI: 10.1002/ueg2.12070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/25/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
Background The relationship between body weight and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Objectives This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP‐related complications in patients who underwent ERCP. Methods We conducted a US population‐based retrospective cohort study using the Nationwide Readmissions Databases (2013–2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9584 (6.02%) were morbidly obese. The primary outcome was in‐hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP‐related complications. Multivariate analysis and propensity score (PS) matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders. Results Patients with morbid obesity, as compared to normal‐weight patients, were associated with a significantly higher in‐hospital mortality (hazard ratio [HR]: 5.54; 95% confidence interval [CI]: 1.23–25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR: 1.00; 95% CI: 0.14–7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCP‐related complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients. Conclusions Morbid obesity but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP.
Established knowledge on this subject
1. Obesity is a prevalent phenomenon. 2. The impact of obesity and morbid obesity on mortality in patients undergoing ERCP remains unclear.
Significant and/or new findings of this study?
1. Morbid obesity but not obesity was associated with increased mortality in patients undergoing ERCP.
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Affiliation(s)
- Bing Chen
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York City, New York, USA
| | - Chia-Hung Yo
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ramya Patel
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York City, New York, USA
| | - Bolun Liu
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Ke-Ying Su
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan
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12
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Patlolla SH, Ponamgi SP, Sundaragiri PR, Cheungpasitporn W, Doshi RP, Alla VM, Nicholson WJ, Jaber WA, Vallabhajosyula S. Influence of body mass index on the management and outcomes of acute myocardial infarction-cardiogenic shock in the United States, 2008-2017. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:34-40. [PMID: 33941485 DOI: 10.1016/j.carrev.2021.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are limited data on influence of body mass index (BMI) on outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS). METHODS Adult AMI-CS admissions from 2008 to 2017 were identified from the National Inpatient Sample and stratified by BMI into underweight (<19.9 kg/m2), normal-BMI (19.9-24.9 kg/m2) and overweight/obese (>24.9 kg/m2). Outcomes of interest included in-hospital mortality, invasive cardiac procedures use, hospitalization costs, and discharge disposition. RESULTS Of 339,364 AMI-CS admissions, underweight and overweight/obese constitute 2356 (0.7%) and 46,675 (13.8%), respectively. In 2017, compared to 2008, there was an increase in underweight (adjusted odds ratio [aOR] 6.40 [95% confidence interval {CI} 4.91-8.31]; p < 0.001) and overweight/obese admissions (aOR 2.93 [95% CI 2.78-3.10]; p < 0.001). Underweight admissions were on average older, female, with non-ST-segment-elevation AMI-CS, and higher comorbidity. Compared to normal and overweight/obese admissions, underweight admissions had lower rates of coronary angiography (57% vs 72% vs 78%), percutaneous coronary intervention (40% vs 54% vs 54%), and mechanical circulatory support (28% vs 46% vs 49%) (p < 0.001). In-hospital mortality was lower in underweight (32.9% vs 34.1%, aOR 0.64 [95% CI 0.57-0.71], p < 0.001) and overweight/obese (27.6% vs 38.4%, aOR 0.89 [95% CI 0.87-0.92], p < 0.001) admissions. Higher hospitalization costs were seen in overweight/obese admissions while underweight admissions were discharged more often to skilled nursing facilities. CONCLUSION Underweight patients received less frequent cardiac procedures and were discharged more often to skilled nursing facilities. Underweight and overweight/obese AMI-CS admissions had lower in-hospital mortality compared to normal BMI.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Shiva P Ponamgi
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE, United States of America; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States of America
| | | | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Rajkumar P Doshi
- Department of Medicine, University of Nevada Reno School of Medicine, Reno, NV, United States of America
| | - Venkata M Alla
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE, United States of America
| | - William J Nicholson
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Wissam A Jaber
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.
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Appendectomy Hospital Stay: No Difference in Obese Adult or Pediatric Patient Length of Stay Compared to Nonobese Patients. Ochsner J 2021; 21:14-18. [PMID: 33828421 PMCID: PMC7993437 DOI: 10.31486/toj.19.0116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Studies of adult and pediatric patients undergoing appendectomy have reported variable outcomes and operative metrics related to the effect of obesity. The purpose of this study was to investigate the effect of obesity in adult and pediatric patients undergoing appendectomy at our institution. Methods: This single-center retrospective study evaluated the relationship between length of hospital stay for appendectomy and body mass index (BMI). Data obtained from the electronic medical record included age, sex, weight, height, BMI, the number of hours the patient experienced symptoms prior to presentation to the emergency room, the number of hours the patient was admitted prior to surgery, the number of hours of hospital admission after surgery, perforated appendix, preoperative comorbidities, and evidence of preoperative sepsis. Results: During the 3-year study period, 118 adults and 38 children who underwent appendectomy composed the study groups. Patients were stratified by obese and nonobese, with obesity defined as BMI ≥30.0 kg/m2. In adults, we found no significant difference between length of stay in obese (n=45) and nonobese (n=73) patients (79.6 ± 65.5 hours vs 101.6 ± 123.0 hours; P=0.21). In children, we found no significant difference between length of stay in obese (n=9) and nonobese (n=29) patients (92.9 ± 64.6 hours vs 109.0 ± 93.5 hours; P=0.54). Conclusion: Obesity did not affect length of stay in adults and children who underwent appendectomy in the present series.
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14
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Rossi AP, Gottin L, Donadello K, Schweiger V, Nocini R, Taiana M, Zamboni M, Polati E. Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid 19. Nutr Metab Cardiovasc Dis 2021; 31:762-768. [PMID: 33549439 PMCID: PMC7677044 DOI: 10.1016/j.numecd.2020.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Recent studies show that obesity is a risk factor for hospital admission and for critical care need in patients with coronavirus disease 2019 (COVID-19). The aim was to determine whether obesity is a risk factor for unfavourable health outcomes in patients affected by COVID-19 admitted to ICU. METHODS AND RESULTS 95 consecutive patients with COVID-19 (78 males and 18 females) were admitted to ICU and included in the study. Height, weight, BMI, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, CRP, CPK, ICU and hospital length of stay and comorbidities were evaluated. Participants with obesity had a lower 28 day survival rate from ICU admission than normal weight subjects. Cox proportional hazard model-derived estimates, adjusted for age, gender and comorbidity, confirmed the results of the survival analysis (HR:5.30,95%C.I.1.26-22.34). Obese subjects showed longer hospital and ICU stay as compared with normal weight counterpart.Subjects with obesity showed significantly higher CRP and CPK levels than normal weight subjects. CONCLUSION In individuals with obesity, careful management and prompt intervention in case of suspected SARS-CoV-2 infection is necessary to prevent the progression of the disease towards severe outcomes and the increase of hospital treatment costs.
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Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy.
| | - Leonardo Gottin
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Katia Donadello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Vittorio Schweiger
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Verona, AOUI-University Hospital Integrated Trust, Verona, Italy
| | - Matteo Taiana
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Enrico Polati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Section of Anesthesiology, University of Verona, Verona, Italy
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15
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El-Dallal M, Stein DJ, Raita Y, Feuerstein JD. The impact of obesity on hospitalized patients with ulcerative colitis. Ann Gastroenterol 2021; 34:196-201. [PMID: 33654359 PMCID: PMC7903582 DOI: 10.20524/aog.2021.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022] Open
Abstract
Background Obesity is the fifth leading risk factor for mortality in the world and it has increased among patients with ulcerative colitis in recent years. We examined the impact of obesity on the hospitalized patients admitted primarily with a diagnosis of ulcerative colitis. Methods We used the National Inpatient Sample data for the year 2016 to identify patients with ulcerative colitis and compared obese and non-obese patients in terms of length of hospital stay, total charges, and mortality. We used multiple imputations to estimate missing values and survey analysis to estimate the outcomes, and we adjusted for confounders by implementing the inverse probability of treatment weighting using propensity score. Results A total of 61,075 admissions with ulcerative colitis were identified. Among these, 6020 were diagnosed with obesity. Baseline hospital and patient characteristics between the 2 groups were notable for differences in age and sex. Patients with obesity were found to have a mean hospital stay longer by 0.57 days (95% confidence interval [CI] 0.22-0.93; P=0.002) and charges $6341.71 higher (95%CI 2499.72-10,183.71; P=0.001) compared to non-obese patients. There was no difference in hospital mortality, with an odds ratio of 0.28 (95%CI 0.04-2.05; P=0.212). Conclusion In a comprehensive review of inpatient admissions in 2016, primarily for ulcerative colitis, obesity was associated with a longer hospital stay and higher total charges per admission after balancing of confounders.
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Affiliation(s)
- Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA (Mohammed El-Dallal).,Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Mohammed El-Dallal, Joseph D. Feuerstein)
| | - Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Daniel J. Stein)
| | - Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Yoshihiko Raita), USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Mohammed El-Dallal, Joseph D. Feuerstein)
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16
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Choi C, Barajas-Ochoa A, Uppuluri A, Ro G, Hashemipour R, Jiang Y, Nasir U, Ahlawat S. The impact of bariatric surgery on in-patient clinical outcomes among patients with autoimmune hepatitis. Medicine (Baltimore) 2020; 99:e22446. [PMID: 33080679 PMCID: PMC7572015 DOI: 10.1097/md.0000000000022446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Autoimmune hepatitis (AIH) is a form of liver inflammation in which immune cells target hepatocytes, inducing chronic inflammatory states. Bariatric surgery (BS) was shown to reduce inflammation in severely obese patients. We hypothesize that obese patients with AIH and BS have lower prevalence of liver-related complications and in-patient mortality compared to those without BS.The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with a diagnosis of AIH. Of those, hospitalizations with BS were selected as cases and those with morbid obesity as controls. Case-control 1:2 matching was done based on sex, age, race, and comorbidities. Primary outcomes were prevalence of liver-related complications and in-patient mortality. Independent risk factors of in-patient clinical outcomes were identified using multivariate regression analysis.From 137,834 hospitalizations with a diagnosis of AIH, 688 with BS were selected as cases, and 1295 were matched as controls. The prevalence of ascites was higher in the BS group compared to the control (odds ratio 1.73, 95% confidence interval (CI) 1.27-2.36). The prevalence of cirrhosis (36.8% vs 33.2%), portal hypertension (7.4% vs 10.0%), hepatic encephalopathy (10.6% vs 8.7%), and varices and variceal bleeding (3.9% vs 5.5%) was not statistically different from case controls, (P > .05).BS was an independent risk factor for ascites (adjusted odds ratio (aOR) 1.87; 95% CI 1.36-2.56) and hepatic encephalopathy (aOR 1.42; 95% CI 1.03-1.97) but was an independent protective factor against in-patient mortality (aOR 0.21, 95% CI 0.08-0.55) once adjusted for age, sex, race, and comorbidities.
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Affiliation(s)
| | | | | | - Grace Ro
- Rutgers New Jersey Medical School
| | - Reza Hashemipour
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yi Jiang
- Internal Medicine, Rutgers New Jersey Medical School
| | - Umair Nasir
- Internal Medicine, Rutgers New Jersey Medical School
| | - Sushil Ahlawat
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ, USA
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17
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Roark CD, Beseler C, Wiley LK, Case D, Folzenlogen Z, Hosokawa P, Seinfeld J. Predictors of 90-Day Readmission Rate After Unruptured Intracranial Aneurysm Repair. World Neurosurg 2020; 141:e728-e735. [PMID: 32525089 DOI: 10.1016/j.wneu.2020.05.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The repair of unruptured intracranial aneurysms has increased since 2000. In this study, we analyzed the Nationwide Readmission Database (NRD) to determine the rate of 90-day readmission. Our objective is to examine readmission trends after unruptured aneurysm repair. METHODS This study used the 2013 and 2014 NRD. Patient data included standard demographic, comorbidity, and payer information. We selected patients who had undergone microsurgical or endovascular repair for a nonruptured aneurysm. We excluded patients who were under 18 years of age, had a subarachnoid hemorrhage, or were discharged to home the same day. Readmission was calculated by counting the number of days between the end of the index visit and earliest readmission date. RESULTS A total of 2180 of 29,694 patients (7.34%) were readmitted within 90 days of their initial hospitalization. They were younger (mean, 52.6 years; 95% confidence interval [CI], 51.4-53.8) than patients not readmitted (mean, 57.4 years; 95% CI, 57.1-57.8; P < 0.0001). In total, endovascular repair was more frequent than microsurgery (79.8% vs. 20.2%, respectively). Mean days to readmission was 41.8 (95% CI, 39.7-43.9) and was higher for women (P < 0.0001). The odds ratio for readmission after an endovascular repair was 1.54 (95% CI, 1.27-1.86). CONCLUSIONS In this study of over 28,000 patients treated for an unruptured aneurysm, the 90-day readmission rate was 7.34%. Endovascular patients had higher odds of readmission than microsurgical patients. Patients with common medical comorbidities (hypertension, obesity, renal failure, and diabetes) were less likely to be readmitted than patients without those conditions.
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Affiliation(s)
| | - Cheryl Beseler
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Laura K Wiley
- Division of Bioinformatics and Personalized Medicine, University of Colorado, Aurora, Colorado, USA
| | - David Case
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
| | - Zach Folzenlogen
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
| | - Patrick Hosokawa
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, Colorado, USA
| | - Joshua Seinfeld
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA; Department of Radiology, University of Colorado, Aurora, Colorado, USA
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18
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Othman F, Ismaiel Y, Alkhathran S, Alshamrani A, Alghamdi M, Ismaeil T. The duration of mechanical ventilation in patients with chronic obstructive pulmonary disease and acute respiratory distress syndrome admitted to the intensive care unit: Epidemiological findings from a tertiary hospital. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_188_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Kyler KE, Bettenhausen JL, Hall M, Hampl S. Prevalence and Trends in Obesity Among Hospitalized Children. Hosp Pediatr 2019; 9:897-902. [PMID: 31645359 DOI: 10.1542/hpeds.2019-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES As obesity rates rise in children, it is likely that the number of hospitalized children with obesity is also increasing. However, characterization of the inpatient population with obesity as a whole has not been reported. We aimed to examine trends in the annual prevalence of obesity in hospitalized children and to identify demographic and clinical characteristics associated with higher obesity prevalence in children who are hospitalized. METHODS We completed a retrospective cohort analysis of children aged 2 to 19 years admitted to a single tertiary children's hospital system for any reason in 2009-2016. Body mass index was calculated from documented height and weight. Children with obesity were defined by using age- and sex-specific body mass index percentile guidelines established by the Centers for Disease Control and Prevention. Annual obesity prevalence was calculated on the encounter level for service line and All Patients Refined Diagnosis-Related Groups (diagnosis groups). χ2 tests were used to determine statistical differences between groups, and the Cochran-Armitage test of trend was used to describe changes in obesity over time. RESULTS Of 83 329 children who were hospitalized, 17.0% had obesity, increasing from 16.5% of hospitalizations in 2009-2010 to 17.3% in 2015-2016 (P = .002). Service lines with the highest obesity prevalence included orthopedics (22.1%), infectious disease (20.6%), and neuroscience (18.7%). Diagnosis groups with the highest obesity prevalence included cellulitis (22.5%), tonsil/adenoid procedures (22.0%), and some orthopedic procedures (28.7%). CONCLUSIONS Some groups of children who were hospitalized experience higher obesity prevalence, including children hospitalized with orthopedic, infectious disease, and neurologic problems. In future research, investigators should target disproportionately affected groups by examining health outcomes, patient safety, and satisfaction issues.
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Affiliation(s)
| | | | - Matthew Hall
- Division of Hospital Medicine and
- Children's Hospital Association, Lenexa, Kansas
| | - Sarah Hampl
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri; and
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20
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Nutritional status significantly affects hospital length of stay among surgical patients in public hospitals of Northern Ethiopia: single cohort study. BMC Res Notes 2019; 12:416. [PMID: 31307530 PMCID: PMC6631984 DOI: 10.1186/s13104-019-4451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aimed to assess the effect of nutritional status on length of hospital stay in Northern Ethiopia. RESULT Institutional based prospective cohort study was conducted among 324 admitted surgical patients. Length of hospital stay were significantly associated with duration of disease (Adjusted Hazard Ratio (AHR) = 3.7,95% Confidence interval (CI):2.35-5.82), history of surgery (AHR = 1.4, 95% CI 1.40, 95% CI 1.17-1.86), nutritional status (Body Mass Index (AHR = 1.38, 95% CI 1.28-1.51), Mid Upper Arm Circumference (AHR = 1.29, 95% CI 1.04-1.62)) and individual diet diversity score (AHR = 2.64, 95% CI 1.14-6.14). Screening of patients for malnutrition at admission and provision of dietary supplements based on their nutritional status is recommended.
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21
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Miao JP, Quan XQ, Zhang CT, Zhu H, Ye M, Shen LY, Guo QH, Zhu GY, Mei QJ, Wu YX, Li SG, Zhou HL. Comparison of two malnutrition risk screening tools with nutritional biochemical parameters, BMI and length of stay in Chinese geriatric inpatients: a multicenter, cross-sectional study. BMJ Open 2019; 9:e022993. [PMID: 30782871 PMCID: PMC6411257 DOI: 10.1136/bmjopen-2018-022993] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess malnutrition risk in Chinese geriatric inpatients using Nutritional Risk Screening 2002 (NRS2002) and Mini-Nutritional Assessment (MNA), and to identify the most appropriate nutritional screening tool for these patients. DESIGN Cross-sectional study. SETTING Eight medical centres in Hubei Province, China. PARTICIPANTS A total of 425 inpatients aged ≥70 years were consecutively recruited between December 2014 and May 2016. PRIMARY AND SECONDARY OUTCOME MEASURES Nutritional risk was assessed using NRS2002, MNA, anthropometric measurements and biochemical parameters within 24 hours of admission. Comorbidities and length of hospitalisation were recorded. Nutritional parameters, body mass index (BMI) and length of hospital stay (LOS) were employed to compare MNA and NRS2002. Kappa analysis was used to evaluate the consistency of the two tools. RESULTS The average age was 81.2±5.9 years (range, 70-98). The prevalence of undernutrition classified by NRS2002 and MNA was 40.9% and 58.6%, respectively. Patients undergoing malnutrition had lower BMI, haemoglobin, albumin and prealbumin (p<0.05), and longer LOS (p<0.05). The NRS2002 showed moderate agreement (κ=0.521, p<0.001) with MNA. Both tools presented significant correlation with age, BMI and laboratory parameters (p<0.001). In addition, a significant association between both tools and LOS was found (p<0.05). In addition, the NRS2002 was not different from MNA in predicting nutritional risk in terms of the area under the receiver operating characteristic curve (p>0.05). CONCLUSIONS The results show a relatively high prevalence of malnutrition risk in our sample cohort. We found that NRS2002 and MNA were both suitable in screening malnutrition risk among Chinese geriatric inpatients.
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Affiliation(s)
- Jian-Ping Miao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
| | - Xiao-Qing Quan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
| | - Cun-Tai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
| | - Hong Zhu
- Department of Geriatrics, The Central Hospital of Wuhan University, Wuhan, China
| | - Mei Ye
- Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Li-Ya Shen
- Department of Geriatrics, Wuhan No 6 Hospital, Wuhan, China
| | - Qiu-Hui Guo
- Department of Geriatrics, Wuhan No 6 Hospital, Wuhan, China
| | - Gang-Yan Zhu
- Department of Geriatrics, Hubei General Hospital, Wuhan, China
| | - Qi-Jian Mei
- Department of Geriatrics, General Hospital of the Yangtze River Shipping, Wuhan, China
| | - Yan-Xia Wu
- Department of Geriatrics, Wuhan No 1 Hospital, Wuhan, China
| | - Shu-Guo Li
- Department of Geriatrics, First Clinical Medical College, Three Gorges University and Yichang Central People’s Hospital, Yichang, China
| | - Hong-Lian Zhou
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
- Wuhan Clinical Research Center for Treatment and Rehabilitation of Elderly Multi-Organ Dysfunction, Wuhan, China
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Harris CM, Abougergi MS, Wright SM. Clinical outcomes among morbidly obese patients hospitalized with diabetic foot complications. Clin Obes 2019; 9:e12285. [PMID: 30288938 DOI: 10.1111/cob.12285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/15/2018] [Accepted: 08/26/2018] [Indexed: 11/29/2022]
Abstract
The aim of the study is to investigate effects of morbid obesity on patients hospitalized with diabetic foot ulcers and infections (DFU/Is). This retrospective cohort study of hospitalized adults investigated patients with a principal diagnosis of DFU/Is, and compared outcomes based on weight. The primary outcome was lower limb amputations. Secondary outcomes included in-hospital mortality, morbidity (sepsis and discharge disposition), resource utilization (length of stay [LOS] and total hospitalization charges). Multivariate analyses adjusted for confounders. A total of 31 730 admissions were included; 14% were morbidly obese. Patients with morbid obesity had overall lower rates of amputations (adjusted odds ratio [aOR]: 0.60; 95% confidence interval [CI]: 0.45-0.80). There was no difference in mortality rates between those who were morbidly obese and the non-morbidly obese patients (aOR: 3.89 [95% CI: 0.79-19.30]). Combined data from 2010 to 2014 have found higher odds of sepsis in morbidly obese patients compared with non-morbidly obese patients after adjusting for confounders (aOR: 1.49 [1.09-2.02], P = 0.01). Patients with morbid obesity were less likely to be discharged to home (aOR: 0.82 [95% CI: 0.70-0.95]), had longer LOS (adjusted mean difference [aMD]: 0.47 [95% CI: 0.13-0.81]) and higher hospital charges (aMD: $3205 [95% CI: $3373-$6037]). Despite having lower amputation rates compared to those who are not morbidly obese, patients with morbid obesity hospitalized for DFU/Is succumbed to sepsis more frequently and had less favourable utilization metrics. Specialized care pathways may be needed to enhance the value of care delivered to this high-risk population.
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Affiliation(s)
- Che Matthew Harris
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marwan S Abougergi
- Department on Internal Medicine, Division of Gastroenterology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
- Catalyst Medical Consulting, Simpsonville, South Carolina, USA
| | - Scott Mitchell Wright
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Rim CH, Kim CY, Yang DS, Yoon WS. Clinical Significance of Gender and Body Mass Index in Asian Patients with Colorectal Cancer. J Cancer 2019; 10:682-688. [PMID: 30719166 PMCID: PMC6360425 DOI: 10.7150/jca.28495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022] Open
Abstract
Objective: Colorectal cancer is a disease closely associated with anthropometric values. This study aimed to evaluate the clinical relevance of gender and body mass index (BMI) with colorectal cancer using a Korean nationwide cohort. Methods: Data of colorectal cancer cohorts between 2012 and 2013 were acquired from the Health Insurance Review and Assessment Service. All patients underwent surgery due to colorectal cancers. Stage IV patients were excluded due to possible clinical heterogeneity. BMI was classified with the World Health Organization criteria. Results: A total of 31,756 patients were analyzed. The underweight group had 33% higher risk of stage III disease (p<0.001). The overweight and obese groups had 20% and 19% lower risk of stage III (p<0.001 and p=0.002, respectively). The underweight and obese groups had higher risk of longest hospitalization period quartile (≥19 days), with odds ratio of 2.26 (p<0.001) and 1.33 (p<0.001), respectively. The overweight group had a 22% lower risk of the longest hospitalization period quartile (p=0.002). Females had 12% lower risk of distal cancer than males (p<0.001). There was no significant relationship between cancer stage and gender. The proportions of patients who were <50 years and ≥70 years old were higher in the females, and the proportions of patients in their 50s and 60s were higher in the males. Conclusions: Cancer stages and hospitalization period varied depending on BMI. Disease location and the age distribution were affected by gender.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea
| | - Chul Yong Kim
- Department of Radiation Oncology, Anam Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Dae Sik Yang
- Department of Radiation Oncology, Guro Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea
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Woolley C, Thompson C, Hakendorf P, Horwood C. The Effect of Age upon the Interrelationship of BMI and Inpatient Health Outcomes. J Nutr Health Aging 2019; 23:558-563. [PMID: 31233078 DOI: 10.1007/s12603-019-1206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES There is growing evidence that the relationship between body mass index (BMI - defined as weight in kilograms divided by height in metres squared) and patient outcomes is age-dependent; specifically, a raised BMI may have a protective effect in older adults. This has been demonstrated clearly in the community setting; less clear is the effect of age on this relationship in the inpatient setting. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Retrospective analysis of 22,903 electronic records for patients discharged from two large public hospitals in South Australia between January 2015 and September 2018 inclusively. Records were retained if the patient's height and weight had been recorded during the admission, BMI was between 10-99 kg/m2 and it was the patient's first admission during that time. Patients were grouped by BMI (<18.5 kg/m2 ("underweight"), 18.5-24.9 kg/m2 ("normal weight"), 25-29.9 kg/m2 ("overweight"), >30 kg/m2 ("obese")) and age (18-59 years, 60-79 years, > 80 years); for each group we measured the relative stay index (RSI) (actual length of stay divided by predicted length of stay), death in hospital and composite adverse outcome after discharge (unplanned readmission within 30 days and/or death within 30 days). RESULTS Underweight patients across all age groups generally experienced significantly poorer outcomes compared to those not underweight. In those aged 18-59 years there were no significant differences in outcomes between the normal weight, overweight and obese groups. In those aged 60-79 years overweight patients had a significantly reduced risk of RSI > 2 compared to those of normal weight (p=0.014), and both overweight and obese patients had a significantly reduced risk of adverse outcome after discharge when compared to those of normal weight (p=0.028 and p=0.009 respectively). In those aged 80 years or older, both overweight and obese patients had a significantly reduced risk of adverse outcome after discharge when compared to those of normal weight (p=0.028 and p=0.013 respectively), and obese patients had a significantly reduced risk of inpatient mortality and RSI >2 when compared to those of normal weight (p=0.027 and p=0.037 respectively). CONCLUSION A BMI > 25 kg/m2 in older patients is associated with reduced risk of prolonged admission, inpatient mortality and adverse outcomes following discharge. This adds to growing evidence that age-specific BMI guidelines are required for adults because the healthiest BMI in the older hospital patient is seemingly not in the range 18.5-24.9 kg/m2.
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Affiliation(s)
- C Woolley
- C Woolley, School of Medicine, University of Adelaide, South Australia, Australia,
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Luthe SK, Hirayama A, Goto T, Faridi MK, Camargo CA, Hasegawa K. Association Between Obesity and Acute Severity Among Patients Hospitalized for Asthma Exacerbation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1936-1941.e4. [PMID: 29452277 PMCID: PMC7723818 DOI: 10.1016/j.jaip.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although studies have demonstrated relations between obesity and incident asthma, little is known about the association of obesity with acute severity in adults hospitalized for asthma exacerbation. OBJECTIVES To investigate the association of obesity with acute severity of asthma exacerbation. METHODS This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) hospitalized for asthma exacerbation. The outcome measures were markers of acute severity-use of mechanical ventilation (defined by noninvasive positive pressure ventilation and/or invasive mechanical ventilation) and hospital length of stay. To determine the association of obesity with each outcome, we fit multivariable models adjusting for patient-level confounders (eg, age, sex, race/ethnicity, primary insurance, quartiles for household income, residential status, and comorbidities) and potential patient clustering within hospitals. RESULTS Among the 72,086 patients hospitalized for asthma exacerbation, 24% were obese. Obesity was associated with a significantly higher risk of any mechanical ventilation use (8.3% vs 5.0%; adjusted odds ratio [OR], 1.77; 95% CI, 1.63-1.92; P < .001) driven by the higher risk of noninvasive positive pressure ventilation use (7.2% vs 3.4%; adjusted OR, 2.14; 95% CI, 1.96-2.35; P < .001). Likewise, obese patients were more likely to have a hospital length of stay of 3 or more days compared with nonobese patients (59.4% vs 46.5%; adjusted OR, 1.37; 95% CI, 1.32-1.43; P < .001). These findings were consistent with stratifications by age, sex, and race/ethnicity. CONCLUSIONS In this population-based study of adults hospitalized for asthma exacerbation, obesity was associated with higher acute severity.
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Affiliation(s)
- Sarah Kyuragi Luthe
- Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
| | - Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Carlos A Camargo
- Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Kohei Hasegawa
- Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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Gender and Physical Activity: Are they Associated with Body Mass Index in Elderly Jordanian People? ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: The number of elderly people is increasing worldwide, and elevated body mass index is a common problem that occur with elderly people, which can be directly or indirectly affected by level of physical activity and gender. So, it is essential to study the effect of both physical activity and gender on body mass index in elderly people.
Material and methods: A cross-sectional, observational study was conducted on 120 elderly Jordanian people who live in Amman (62 women; 58 men) and evaluated for body mass index. Those participants were 40 elderly persons who attended the gym at least twice a week for the last 2 years, and 80 elderly who were home resident or physically inactive. A structured questionnaire was used to collect data about personal, social, health and life-style information including the daily activities and the anthropometric measurements for the study participants.
Results: The results of this study showed that as elderly people become physically inactive, their body mass index will increase to become as overweight or obese. The results of this study also showed that body mass index of 30 and more was associated with gender, with majority of female elderly (50%) having body mass index of 30 or more.
Conclusion: Physical activity should be maintained by both genders in order to prevent obesity, primarily in women as they are more likely to become obese that men. Furthermore, body mass index should not exceed 30 in elderly. Physical activity is essential in order to obtain healthy weight.
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Inabnit LS, Blanchette C, Ruban C. Comorbidities and length of stay in chronic obstructive pulmonary disease patients. COPD 2018; 15:355-360. [PMID: 30273058 DOI: 10.1080/15412555.2018.1513470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) has a significant burden on patients and the healthcare system. There is a link between COPD and comorbidities such as congestive heart failure (CHF), fluid and electrolyte disorders, and renal failure. This adds to the complexity of healthcare in these patients. The objective of this study is to determine if certain comorbidities affect length of stay. A sample of 3,399 patients with COPD were assessed from the Premier© healthcare database. The cohort had a mean (standard deviation (SD)) age of 68.41 (10.85) years. The average number of comorbidities was 24.83 (10.46) with a mean length of stay (SD) of 11.64 (9.40) days. A negative binomial regression model was used to evaluate the impact that comorbidities have on the length of hospital stay. The authors found that the number of comorbidities was associated with an increased length of stay (r = .4596, p < .0001). Having at least one comorbidity was associated with a 13% greater length of stay (IRR = 1.13, 95% CI 1.11-1.15, p < 0.0001). CHF was associated with a 28% greater length of stay (IRR = 1.28, 95% CI 1.24-1.31, p < 0.0001). Fluid and electrolyte disorders were associated with a 2-fold greater length of stay (IRR = 2.57, 95% CI 2.52-2.62, p < 0.0001). Renal failure was associated with a 50% greater length of stay (IRR = 1.50, 95% CI 1.45-1.55, p < 0.0001). However, uncomplicated diabetes was associated with 13% shorter length of stay than not having uncomplicated diabetes (IRR = .87, 95% CI .82-.91, p < .0001). This study demonstrated that specific comorbidities have an impact on length of stay.
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Affiliation(s)
- Lanny S Inabnit
- a BSRT , University of North Carolina-Charlotte , Charlotte , North Carolina , USA
| | - Christopher Blanchette
- b Public Health Sciences , University of North Carolina-Charlotte , Charlotte , North Carolina , USA
| | - Cynthiya Ruban
- c University of North Carolina-Charlotte , Charlotte , North Carolina , USA
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Gao H, Feng HM, Li B, Lin JP, Yang JB, Zhu DJ, Jing T. Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: A meta-analysis. Medicine (Baltimore) 2018; 97:e11091. [PMID: 29995752 PMCID: PMC6076106 DOI: 10.1097/md.0000000000011091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The impact of high body mass index (BMI, >23/25 kg/m) on surgical outcomes and prognosis in patients with esophageal carcinoma (EC) after undergoing esophagectomy remains controversial. We herein conducted a systematic review and meta-analysis to determine the relationship between high BMI and surgical outcomes and prognosis in patients undergoing esophagectomy for EC. METHODS The study search was conducted by retrieving publications from the PubMed, Embase, Web of Science, and CNKI (up to September 8, 2017). Nineteen studies with 13,756 patients were included in this meta-analysis. RESULTS We found that high BMI was closely associated with a higher incidence of wound infection (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.02-1.97, P = .04), cardiovascular complications (OR: 2.51, 95% CI, 1.65-3.81, P < .0001), and anastomotic leakage (OR: 1.50, 95% CI, 1.21-1.84, P = .0002), but a lower incidence of chylous leakage (OR: 0.59, 95% CI, 0.40-0.88, P = .01) when compared with normal BMI. The high BMI group was not associated with better or worse overall survival (OS) (hazard ratio [HR]: 0.95, 95% CI, 0.85-1.07, P = .4) and disease-free survival (HR: 0.95, 95% CI, 0.72-1.25, P = .72) than the normal BMI group. However, in the subgroup analysis, the pooled result of HRs generated from multivariate analyses suggested that high BMI could improve OS in EC patients (HR: 0.84, 95% CI, 0.76-0.93, P < .01). CONCLUSIONS Overweight patients with EC should not be denied surgical treatment, but intraoperative prevention and careful postoperative monitoring for several surgical complications must be stressed for this population. Besides, high BMI might be a prognostic predictor in EC patients; further studies are warranted.
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Affiliation(s)
| | - Hai-Ming Feng
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Jun-Ping Lin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Jian-Bao Yang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Duo-Jie Zhu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Tao Jing
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
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Rossi AP, Fantin F, Abete P, Bellelli G, Bo M, Cherubini A, Corica F, Di Bari M, Maggio M, Manca GM, Rizzo MR, Bianchi L, Landi F, Volpato S. Association between hospitalization-related outcomes, dynapenia and body mass index: The Glisten Study. Eur J Clin Nutr 2018; 73:743-750. [PMID: 29872161 DOI: 10.1038/s41430-018-0184-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/04/2017] [Accepted: 03/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the prognostic value of dynapenia, as evaluated by handgrip, and body mass index (BMI) on length of stay (LOS), days of bed rest, and other hospitalization-related outcomes in a population of older adults admitted to 12 italian acute care divisions. METHODS Data on age, weight, BMI, comorbidities, ADL, physical activity level, muscle strength, were recorded at hospital admission. LOS, days of bed rest, intrahospital falls, and discharge destination were also recorded during the hospitalization. Subjects with BMI <18.5 kg/m2 were classified as underweight, subjects with BMI 18.5-24.9 as normal weight, subjects with BMI ≥25 as overweight-obese. RESULTS A total of 634 patients, mean age 80.8 ± 6.7 years and 49.4% women, were included in the analysis. Overall dynapenic subjects (D) showed a longer period of LOS and bed rest compared with non-dynapenic (ND). When the study population was divided according to BMI categories, underweight (UW), normal weight (NW), and overweight-obese (OW-OB), no significant differences were observed in hospital LOS and days of bed rest. When analysis of covariance was used to determine the difference of LOS across handgrip/BMI groups, D/OW-OB and D/UW subjects showed significantly longer LOS (11.32 and 10.96 days, both p 0.05) compared to ND/NW subjects (7.69 days), even when controlling for age, gender, baseline ADL, cause of hospitalization and comorbidity. After controlling for the same confounding factors, D/OW-OB, D/NW and D/UW subjects showed significantly longer bed rest (4.7, 4.56, and 4.05 days, respectively, all p 0.05, but D/OW-OB p 0.01) compared to ND/NW subjects (1.59 days). CONCLUSION In our study population, LOS is longer in D/UW and D/OW-OB compared to ND/NW subjects and days of bed rest are mainly influenced by dynapenia, and not by BMI class.
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Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Geriatrics Division, Healthy Aging Center Verona, University of Verona, Verona, Italy.
| | - Francesco Fantin
- Department of Medicine, Geriatrics Division, Healthy Aging Center Verona, University of Verona, Verona, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Italy Geriatric Unit, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Mario Bo
- Geriatrics and Bone Metabolism Disease Department, Citta' della Salute e della Scienza-Molinette, Turin, Italy
| | - Antonio Cherubini
- IRCCS-INRCA, Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, Ancona, Italy
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mauro Di Bari
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Aging, University of Florence, Florence, Italy.,Department of Geriatrics and Medicine, Geriatric Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Clinical and Experimental Medicine, Geriatric Rehabilitation Department, University of Parma, Parma, Italy
| | | | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Naples, Naples, Italy
| | - Lara Bianchi
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
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30
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Boi SK, Moore JX, Royston KJ, Demark-Wahnefried W. Letter to the Editor: Vagal Blocking (vBloc) Therapy: a New Era of Clinical Therapy for Extreme Obesity : Re: Apovian et al. Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial. Obesity Surgery. 2016. Obes Surg 2018; 27:483-484. [PMID: 27933506 DOI: 10.1007/s11695-016-2484-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Shannon K Boi
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Graduate Biomedical Sciences - Immunology Theme, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Justin X Moore
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kendra J Royston
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Akirov A, Shochat T, Masri-Iraqi H, Dicker D, Diker-Cohen T, Shimon I. Body mass index and mortality in patients with and without diabetes mellitus. Diabetes Metab Res Rev 2018; 34:e2979. [PMID: 29281762 DOI: 10.1002/dmrr.2979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/30/2017] [Accepted: 12/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Investigate the association between body mass index (BMI), length of stay (LOS), and mortality in hospitalized patients with and without diabetes mellitus (DM). METHODS Historical prospectively collected data of adult patients hospitalized between 2011 and 2013. Body mass index was calculated according to measurement or self-report on admission and classified as follows: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (30-34.9), and severely obese (≥35). The main outcomes were LOS, in-hospital, and end-of-follow-up mortality. RESULTS Cohort included 24 233 patients (53% male; mean age ± SD, 65 ± 18), including 7397 patients with DM (31%). Among patients with normal BMI, LOS was shorter compared with underweight patients, but it was longer compared with overweight and obese patients. Following multivariate adjustment, this difference remained significant only for patients with DM. There was a significant interaction between DM status and BMI group, in the models for in-hospital and end-of-follow-up mortality. Compared with normal BMI, in-hospital mortality risk was increased by 80% and 100% for the underweight with and without DM, respectively. For patients with and without DM, in-hospital mortality risk was 30% to 40% lower among overweight and obese patients, and there was no difference between severely obese and normal weight patients. At the end-of-follow-up, mortality risk was 1.6-fold and 1.7-fold higher among underweight patients with and without DM, respectively. For overweight, obese, and severely obese patients, mortality risk was decreased by 30% to 40% in those with DM and by 20% to 30% in those without DM. CONCLUSIONS In hospitalized patients with and without DM, there was an inverse association between BMI and mortality.
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Affiliation(s)
- Amit Akirov
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzipora Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Hiba Masri-Iraqi
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Dicker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel
| | - Talia Diker-Cohen
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine A, Beilinson Hospital, Petach Tikva, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Compher C, Higashiguchi T, Yu J, Jensen GL. Does Low Body Mass Index Predict the Hospital Mortality of Adult Western or Asian Patients? JPEN J Parenter Enteral Nutr 2017. [DOI: 10.1177/0148607117713182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Takashi Higashiguchi
- Department of Surgery and Palliative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Gordon L. Jensen
- College of Medicine, University of Vermont, Burlington, Vermont, USA
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