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Stumpfe MC, Platzer J, Horch RE, Geierlehner A, Arkudas A, Mueller-Seubert W, Cai A, Promny T, Ludolph I. Analysis of laboratory markers in body contouring procedures after bariatric surgery does not indicate particular risks for perioperative complications. Perioper Med (Lond) 2024; 13:63. [PMID: 38937810 PMCID: PMC11210174 DOI: 10.1186/s13741-024-00422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/13/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Body contouring surgery after massive weight loss is associated with different risk factors. Wound healing disorders and seromas commonly occur postoperatively. Bariatric interventions lead to massive weight loss with excess skin and soft tissue. In this study, perioperatively collected laboratory markers of this special patient population were analyzed. METHODS Fifty-nine patients were analyzed retrospectively regarding bariatric surgery, weight loss, body contouring surgery, laboratory markers, and complication rates. RESULTS Body contouring surgery (n = 117) was performed in 59 patients. Weight loss was achieved after gastric bypass (40.1%), gastric banding (33.9%), or sleeve gastrectomy (26.0%), with an average of 69.2 kg. The most common body contouring procedure included abdominoplasty (n = 50), followed by thigh lift (n = 29), mammaplasty (n = 19), brachioplasty (n = 14), and upper body lift (n = 5). Analysis of laboratory markers revealed no exceptional and clinically relevant variations. Correlation analysis revealed associations between resection weight, amount of drain fluid, and particular laboratory markers. CONCLUSION Analysis of perioperative laboratory markers in this special patient population after massive weight loss did not indicate clinically relevant risk factors regardless of the type of bariatric or body contouring surgery. Body contouring surgeries after bariatric interventions prove to be safe and low risk concerning perioperative laboratory markers and postoperative hospitalization.
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Affiliation(s)
- Maximilian C Stumpfe
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany.
| | - Juliane Platzer
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Alexander Geierlehner
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Wibke Mueller-Seubert
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Aijia Cai
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Theresa Promny
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstraße 12, Erlangen, 91054, Germany
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Ba DM, Hu A, Shen C, Leslie DL, Chinchilli VM, Rogers AM, Al-Shaar L. Trends and predictors of nutritional deficiencies after bariatric surgeries: analysis of real-world data. Surg Obes Relat Dis 2023; 19:935-943. [PMID: 37005153 DOI: 10.1016/j.soard.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Bariatric surgery (BS) can lead to postoperative nutritional deficiencies (NDs) due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying NDs' prevalence over time and their predictors among patients undergoing BS. OBJECTIVE To characterize time trends and predictors of postoperative NDs. SETTING This retrospective cohort study used the U.S. IBM MarketScan commercial claims database (2005-2019) to include adults who underwent BS with continuous enrollment. METHODS BS included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric band (AGB), and biliopancreatic diversion with duodenal switch. NDs included protein malnutrition, deficiencies in vitamins D and B12, and anemia that may be related to NDs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NDs across BS types after adjusting for other patient factors. RESULTS Within 83,635 patients (mean age [SD], 44.5 [9.5] yr; 78% female patients), 38.7%, 32.9%, and 28% underwent RYGB, SG, and AGB, respectively. Age-adjusted prevalence of any NDs within 1, 2, and 3 years after BS ranged from 23%, 34%, and 42%, respectively (in 2006) to 44%, 54%, and 61%, respectively (in 2016). Relative to the AGB group, the adjusted OR of any 3-year postoperative NDs was 3.00 (95% CI, 2.89-3.11) for the RYGB group and 2.42 (95% CI, 2.33-2.51) for the SG group. CONCLUSIONS RYGB and SG were associated with 2.4- to 3.0-fold odds of developing 3-year postoperative NDs compared with AGB, independent of baseline ND status. Pre- and postoperative nutritional assessments are recommended for all patients undergoing BS to optimize postoperative outcomes.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Antoinette Hu
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
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Alhammoud A, Dalal S, Sheha ED, Habibullah NK, Moghamis IS, Virk S, Gang CH, Qureshi SA. The Impact of Prior Bariatric Surgery on Outcomes After Spine Surgery: A Systematic Review and meta-Analysis. Global Spine J 2022; 12:1872-1880. [PMID: 35057660 PMCID: PMC9609509 DOI: 10.1177/21925682211072492] [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] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To compare outcomes and complication rates in patients undergoing bariatric surgery (BS) prior to spine surgery. METHODS A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines comparing the outcomes of spine surgery between subjects with prior bariatric surgery to those who were considered obese with no prior bariatric surgery. RESULTS A total of 183, 570 patients were included in the 4 studies meeting inclusion criteria. The mean patient age was 52.9 years, and the majority were female (68%). The two groups consisted of a total of 36, 876 patients with prior BS and 146, 694 obese patients without prior BS. The overall rate of complications in the prior BS group was 6.4% (4.5%-38.7%) compared to 11.9% (11.2%-55.4%) in the non-prior BS obese group with a statistically significant difference between the two groups. The prior BS group had lower rates of renal, neurological, and thromboembolic complications, with a lower mortality and readmission rate. In a subgroup undergoing cervical spine surgery, patients with prior BS had fewer cardiac, GI, and total complications. For patients undergoing thoracolumbar spine surgery, patients with prior BS had fewer thromboembolic and total complications. CONCLUSION Patients undergoing bariatric surgery prior to spine surgery had fewer renal, neurological, and thromboembolic complications as well as a decreased mortality and readmission rate.
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Affiliation(s)
| | | | - Evan D. Sheha
- Hospital for Special
Surgery, New York, NY, USA,Weill Cornell Medical
College, New York, NY, USA
| | | | | | - Sohrab Virk
- Hospital for Special
Surgery, New York, NY, USA
| | | | - Sheeraz A Qureshi
- Hospital for Special
Surgery, New York, NY, USA,Weill Cornell Medical
College, New York, NY, USA,Hospital for Special Surgery, New York, NY,
USASheeraz A Qureshi, MD, MBA, Hospital for Special Surgery, 535 E. 70th St.,
New York, NY 10021, USA.
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Jamil LC, Suzuki VY, Ferreira LM. Preoperative Nutritional Parameters for Postbariatric Patients: A Review of Key Recommendations. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Liliane Carvalho Jamil
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Vanessa Yuri Suzuki
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Lydia Masako Ferreira
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
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Toninello P, Montanari A, Bassetto F, Vindigni V, Paoli A. Nutritional Support for Bariatric Surgery Patients: The Skin beyond the Fat. Nutrients 2021; 13:1565. [PMID: 34066564 PMCID: PMC8148584 DOI: 10.3390/nu13051565] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022] Open
Abstract
Body contouring surgery after the massive weight loss due to bariatric surgery deals with different kinds of complications. The aim of this review is to analyze the role that some nutrients may play in tissue healing after surgery, thus helping plastic surgeons to improve the aesthetic and health outcomes in massive weight loss patients under a multidisciplinary approach. As a matter of fact, preoperative nutritional deficiencies have been shown for vitamins and minerals in a large percentage of post-bariatric patients. Preoperative deficiencies mainly concern iron, zinc, selenium, and vitamins (both fat-soluble and water-soluble), but also total protein. During the postoperative period, these problems may increase because of the patients' very low intake of vitamins and minerals after bariatric surgery (below 50% of the recommended dietary allowance) and the patients' low compliance with the suggested multivitamin supplementation (approximately 60%). In the postoperative period, more attention should be given to nutritional aspects in regard to the length of absorptive area and the percentage of weight loss.
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Affiliation(s)
- Paolo Toninello
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, 35122 Padua, Italy; (P.T.); (A.M.); (F.B.); (V.V.)
| | - Alvise Montanari
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, 35122 Padua, Italy; (P.T.); (A.M.); (F.B.); (V.V.)
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, 35122 Padua, Italy; (P.T.); (A.M.); (F.B.); (V.V.)
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, 35122 Padua, Italy; (P.T.); (A.M.); (F.B.); (V.V.)
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, 35122 Padua, Italy
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Gebran SG, Wasicek PJ, Ngaage LM, Nam AJ, Kligman MD, Rasko YM. Panniculectomy at the time of bariatric surgery: a propensity score-matched analysis of outcomes in the MBSAQIP database. Surg Obes Relat Dis 2020; 17:177-184. [PMID: 33054983 DOI: 10.1016/j.soard.2020.08.013] [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: 01/15/2019] [Revised: 07/09/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Body contouring in the postbariatric surgery patient improves quality of life and daily function. OBJECTIVES To determine the risk profile of panniculectomy when performed in select patients at the time of bariatric surgery. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating centers. METHODS We examined the MBSAQIP database (2016-2017), in which data on 379,544 bariatric surgeries are reported. Concurrent panniculectomy procedures were identified by Current Procedural Technology (CPT) codes. Patient characteristics and in-hospital as well as 30-day complications were compared between the body contouring group and propensity score-matched bariatric surgery controls. RESULTS One hundred twenty-four patients met inclusion criteria and were matched to 248 controls. An infra-umbilical panniculectomy was performed in the majority of patients (n = 94, 75.8%). Most patients received an open rather than laparoscopic bariatric surgery (n = 87, 70.2%). There were no statistically significant differences between 30-day mortality (1.9%), wound complications (11.5%), readmission (12.5%) and reoperation (5.8%) between the 2 groups (P > .05). Wound complications occurred in 11.5% of patients and were associated with prolonged hospital stay (odds ratio 4.65, 95% confidence interval 1.99-10.86, P < .001) and a body mass index (BMI) > 50 (odds ratio 3.19, 95% confidence interval 1.02-9.96, P = .046). CONCLUSION In select patients, panniculectomy at the time of bariatric surgery was not associated with increased in-hospital or 30-day adverse outcomes compared with matched bariatric surgery controls. This procedure may be performed in select patients, with awareness that revision surgery may be needed once weight loss stabilizes.
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Affiliation(s)
- Selim G Gebran
- Division of Plastic, Reconstructive, & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Philip J Wasicek
- Division of Plastic, Reconstructive, & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Ledibabari M Ngaage
- Division of Plastic and Reconstructive Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Arthur J Nam
- Division of Plastic, Reconstructive, & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Mark D Kligman
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Yvonne M Rasko
- Division of Plastic and Reconstructive Surgery, University of Maryland Medical Center, Baltimore, Maryland.
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7
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O’Kelly N, Nguyen K, Gibstein A, Bradley JP, Tanna N, Matarasso A. Standards and Trends in Lipoabdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3144. [PMID: 33173672 PMCID: PMC7647643 DOI: 10.1097/gox.0000000000003144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lipoabdominoplasty has evolved over the last 6 decades through contributions from numerous luminaries in plastic and reconstructive surgery. METHODS The authors review historical perspective and provide a contemporary examination of trends in lipoabdominoplasty. RESULTS In 1967, Pitanguy popularized abdominoplasty (without liposuction) as a technique for augmenting ventral hernias repairs and subsequently for aesthetic improvement of the abdomen. After the introduction of suction assisted lipectomy by Illouz in 1983, abdominoplasty became a central tool in a diverse armamentarium of anterior and lateral abdominal wall contouring procedures. Liposuction was initially utilized with mini-abdominoplasty in order to improve contour. Subsequently, Matarasso advanced the safe combination of liposuction with full abdominoplasty. Additionally, he systematized the variety of cutaneous undermining, excision, and liposuction procedures utilized in abdominal contouring as indicated by the degree of skin laxity and musculofascial diastasis. Lockwood advocated high lateral tension closure of the superficial fascial system of the abdomen to improve the contour of the hips and flanks. Saldanha advanced selective undermining and anterior abdominal wall perforator preservation to minimize wound healing and seroma complications associated with lipoabdominoplasty procedures. CONCLUSION In abdominal contour surgery, surgeons can rely on classic techniques and algorithms that have withstood the test of time while modifying their approaches with advances backed by compelling and rigorously obtained evidence.
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Affiliation(s)
- Neil O’Kelly
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Khang Nguyen
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Alexander Gibstein
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - James P. Bradley
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Neil Tanna
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
| | - Alan Matarasso
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y
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Wiser I, Plonski L, Shimon N, Friedman T, Heller L. Surgical Site Infection Risk Factor Analysis in Postbariatric Patients Undergoing Body Contouring Surgery: A Nested Case-Control Study. Ann Plast Surg 2020; 82:493-498. [PMID: 30950874 DOI: 10.1097/sap.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) following body-contouring plastic surgery pose a significant burden on patients and caregivers, possibly leading to undesired surgical outcomes. Surgical site infection incidence following body-contouring plastic surgery ranges from 2% to 7%, but is estimated much higher among postbariatric massive weight loss (MWL) patients. OBJECTIVE The aim of this study was to evaluate SSI rate, risk and protective factors among postbariatric MWL patients following body-contouring plastic surgery. METHODS This was a nested case-control study of MWL patients who underwent body-contouring plastic surgery at the Department of Plastic Surgery at Assaf Harofeh Medical Center, between 2007 and 2014. Data were obtained from medical records. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Logistic regression was conducted to assess independent risk factors for SSIs. RESULTS From a cohort of 172 patients, 86 were included in the study. Surgical site infection rate was 20% (n = 17). Significant SSI risk factors included lifetime maximal weight and lifetime maximal body mass index (P = 0.039 and P = 0.002, respectively), body mass index loss prior to surgery (P = 0.032), estimated blood loss during surgery (P = 0.002), and gynecomastia repair procedure (P = 0.038). Independent SSI-associated factors included thigh lift procedure (odds ratio, 4.66; 95% confidence interval, 1.13-19.28) and preoperative antimicrobial prophylaxis (odds ratio, 0.04; 95% confidence interval, 0.03-0.61). CONCLUSIONS Although not required by current guidelines for body-contouring plastic surgery, preoperative antimicrobial prophylaxis in our study demonstrated a significant protective effect against SSIs. Further research may reveal its true contribution to SSI prevention in body-contouring plastic surgery.
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Affiliation(s)
| | - Lori Plonski
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Nitai Shimon
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Tali Friedman
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
| | - Lior Heller
- From the Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, and
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Nickel BT, Klement MR, Penrose C, Green CL, Bolognesi MP, Seyler TM. Dislocation rate increases with bariatric surgery before total hip arthroplasty. Hip Int 2018; 28:559-565. [PMID: 29756506 DOI: 10.1177/1120700017752567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Annually in the USA, 113,000 patients with refractory obesity undergo bariatric surgery (BS), and a subset does so in order to lower body mass index to become a more desirable total hip arthroplasty (THA) candidate. This study aims to evaluate THA risk with and without bariatric surgery. METHODS 12,160 patients were identified in a claim-based review of the entire Medicare database with ICD-9 codes to identify patients in three groups. Patients who underwent BS prior to THA (Group I: 1,545 experimental group) and two control groups that did not undergo BS but had either a body mass index >40 (Group II: 6,918 bariatric control) or <25 (Group III: 3,697 normal weight control). Preoperative demographics/comorbidities and short-term medical (30 day) and long-term surgical (90-day and 2-year) complications were evaluated. RESULTS Group I had female predominance, youngest age, and highest incidence of: deficiency anaemia, cardiovascular disease, liver disease, diabetes, polysubstance abuse, psychiatric disorders and smoking. At 2 years, Group I had approximately twice the dislocation and revision risk compared to both Groups II and III; Groups I and II had over four times the risk of infection and wound complications compared to Group III. CONCLUSION In the Medicare population, these patients continue to have complication rates similar to and sometimes greater than obese patients with no prior bariatric surgery. Greater dislocation risk is possibly due to ligamentous laxity related to decreased collagen/elastin and/or component malposition due to intraoperative visualisation challenges.
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Affiliation(s)
- Brian T Nickel
- 1 Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mitchell R Klement
- 1 Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Colin Penrose
- 1 Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- 2 Duke Department of Biostatistics and Bioinformatics, Durham, North Carolina, USA.,3 Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael P Bolognesi
- 1 Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thorsten M Seyler
- 1 Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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Jain D, Berven SH, Carter J, Zhang AL, Deviren V. Bariatric surgery before elective posterior lumbar fusion is associated with reduced medical complications and infection. Spine J 2018; 18:1526-1532. [PMID: 29408400 DOI: 10.1016/j.spinee.2018.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/11/2018] [Accepted: 01/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Severely obese patients with operative spinal pathology present a challenge to the spine surgeon, given the increased complication risk. PURPOSE We aimed to determine the impact of bariatric surgery (BS) on perioperative complications of posterior lumbar fusion. STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE Patients undergoing posterior lumbar fusion surgery in the State Inpatient Databases of New York, Florida, North Carolina, Nebraska, Utah, and California comprised the patient sample. OUTCOMES Thirty-day medical complications, surgical complications (nerve injury, infection, revision), death, readmission, and hospital length of stay (LOS) were the study's outcomes. METHODS We analyzed 156,517 patients using International Classification of Diseases, Ninth Revision codes. Patients were categorized into three groups: Group 1: history of BS and obesity, Group 2: severe obesity, body mass index (BMI)>40 (severely obese), and Group 3: normal weight, BMI<25 (non-obese). Logistic and linear multivariate regressions were performed to compare complications and LOS, respectively, between BS and severely obese groups and BS and non-obese groups while controlling for confounders. There were no sources of funding for this study. RESULTS There were 590 patients with BS, 5,791 severely obese, and 150,136 non-obese. Comparing BS with severely obese, BS had significantly lower rates of respiratory failure (odds ratio [OR] 0.59, p=.019), urinary tract infection (OR 0.64, p=.031), acute renal failure (OR 0.39, p=.007), overall medical complications (OR 0.59, p<.001), and infection (OR 0.65, p=.025). Bariatric surgery also had significantly lower hospital LOS (B=-0.46, p=.01). Comparing BS with non-obese, there were no significant differences in medical complications; however, BS had significantly higher rates of infection (OR 2.70, p<.001), reoperation (OR 2.05, p=.045), and readmission (OR 1.89, p<.001). CONCLUSION Bariatric surgery before elective posterior lumbar fusion mitigates risk of medical complications and infection. However, these patients still have increased risk of infection, revision surgery, and readmission compared with patients with normal BMI. Surgeons might consider referral for BS for the severely obese patient before undergoing spine surgery.
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Affiliation(s)
- Deeptee Jain
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA.
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA
| | - John Carter
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA
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Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors. Am J Surg 2018; 215:887-890. [PMID: 29439774 DOI: 10.1016/j.amjsurg.2018.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications. METHODS A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period. RESULTS Total 706 patients included. Overall complication rate was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Return to operating room rate was 12%. Significant factors were: BMI >26 (p < 0.01), fleur-de-lis panniculectomy (p < 0.01), concomitant hernia repair (p < 0.01). Multivariate regression analysis demonstrated ASA class >2 (OR 1.97, p < 0.05) and incision type (OR 1.64, p < 0.05) to be independent predictors of morbidity. CONCLUSION High morbidity for post-bariatric panniculectomy is primarily local wound complications. Potentially modifiable factors that increase the complication risk profile include higher BMI, higher ASA class, and the use of fleur-de-lis incision.
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Mencio MA, Ontiveros E, Burdick JS, Leeds SG. Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience. Surg Endosc 2018; 32:3349-3356. [PMID: 29362911 DOI: 10.1007/s00464-018-6055-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perforations and anastomotic leaks of the gastrointestinal tract are severe complications, which carry high morbidity and mortality and management of these is a multi-disciplinary challenge. The use of endoluminal vacuum (EVAC) therapy has recently proven to be a useful technique to manage these complications. We report our institution's experience with this novel technique in the chest, abdomen, and pelvis. METHODS This is a retrospective review of an IRB approved registry of all EVAC therapy patients from July 2013 to December 2016. A total of 55 patients were examined and 49 patients were eligible for inclusion: 15 esophageal, 21 gastric, 3 small bowel, and 10 colorectal defects. The primary endpoint was closure rate of the GI tract defect with EVAC therapy. RESULTS Fifteen (100%) esophageal defects closed with EVAC therapy. Mean duration of therapy was 27 days consisting of an average of 6 endosponge changes every 4.8 days. Eighteen (86%) gastric defects closed with EVAC therapy. Mean duration of therapy was 38 days with a mean of 9 endosponge changes every 5.3 days. Three (100%) small bowel defects closed with EVAC therapy. Mean duration of therapy was 13.7 days with a mean of 2.7 endosponge changes every 4.4 days. Six (60%) colorectal defects closed with EVAC therapy. Mean duration of therapy was 23.2 days, consisting of a mean of 6 endosponge changes every 4.0 days. There were two deaths, which were not directly related to EVAC therapy and occurred outside the measured 30-day mortality. CONCLUSION Our experience demonstrates that EVAC therapy is feasible and effective for the management of gastrointestinal perforations/leaks throughout the GI tract and can be considered as a safe alternative to surgical intervention in select cases.
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Affiliation(s)
- Marissa A Mencio
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, 1st Floor Roberts Hospital, Dallas, TX, 75246, USA
| | - Estrellita Ontiveros
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, 1st Floor Roberts Hospital, Dallas, TX, 75246, USA
| | - James S Burdick
- Department of Gastroenterology, Baylor University Medical Center at Dallas, Dallas, USA
| | - Steven G Leeds
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, 1st Floor Roberts Hospital, Dallas, TX, 75246, USA.
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D’Ettorre M, Tambasco D, Mingrone G, Bracaglia R. Predictive value of biochemical and tissue modifications for wound healing in post-bariatric patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nickel BT, Klement MR, Penrose CT, Green CL, Seyler TM, Bolognesi MP. Lingering Risk: Bariatric Surgery Before Total Knee Arthroplasty. J Arthroplasty 2016; 31:207-11. [PMID: 27179771 DOI: 10.1016/j.arth.2016.02.075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity continues to increase in the United States with an estimated 35% obesity and 8% bariatric (body mass index >40) rate in adults. Bariatric patients seek advice from arthroplasty surgeons regarding the temporality of bariatric surgery (BS), yet no consensus currently exists in the literature. METHODS A total of 39,014 patients were identified in a claim-based review of the entire Medicare database with International Classification of Diseases, Ninth Revision codes to identify patients in 3 groups. Patients who underwent BS before total knee arthroplasty (group I: 5914 experimental group) and 2 control groups that did not undergo BS but had either a body mass index >40 (group II: 6480 bariatric control) or <25 (group III: 26,616 normal weight control). International Classification of Diseases, Ninth Revision, Clinical Modification codes identified preoperative demographics or comorbidities and evaluated short-term medical (30 day) and long-term surgical (90 days and 2 years) complications. RESULTS Group I had the greatest female predominance, youngest age, and highest incidence of: deficiency anemia, cardiovascular disease, pulmonary disease, liver disease, ulcer disease, polysubstance abuse, psychiatric disorders, and smoking. Medical and surgical complication incidences were greatest in group I including: 4.98% deep vein thrombosis; 5.31% pneumonia; 10.09% heart failure; and 2-year infection, revision, and manipulation rates of 5.8%, 7.38%, and 3.13%, respectively. These values were significant elevation compared to III and slightly greater than II. CONCLUSIONS This study demonstrates that BS before total knee arthroplasty is associated with greater risk compared to both nonobese and obese patients. This is possibly due to a higher incidence of medical or psychiatric comorbidities determined in the Medicare BS patients, wound healing difficulties secondary to gastrointestinal malabsorption, malnourishment from prolonged catabolic state, rapid weight loss before surgery, and/or age.
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Affiliation(s)
- Brian T Nickel
- Department of Orthopaedic Surgery, Duke University School of Medicine
| | | | - Colin T Penrose
- Department of Orthopaedic Surgery, Duke University School of Medicine
| | | | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine
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Predictors of vaginal mesh exposure after midurethral sling placement: a case–control study. Int Urogynecol J 2016; 27:1321-6. [DOI: 10.1007/s00192-016-2947-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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