The obesity paradox in surgical patients : From preoperative assessment to long term outcome (original) (raw)
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Obesity in general elective surgery
Lancet, 2003
Interpretation Obesity alone is not a risk factor for postoperative complications. The regressive attitude towards general surgery in obese patients is no longer justified.
The Impact of Obesity on Surgical Outcome after
2015
Context The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. Objective To investigate the specific impact of obesity on pancreaticoduodenectomy. Design A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. Patients Between 1999 and 2006, 92 consecutive patients underwent pancreaticoduodenectomy using a standardized technique. The study population was subdivided according to the presence or absence of obesity. Results Nineteen (20.7%) patients were obese and 73 (79.3%) patients were non-obese. The two groups were comparable in terms of demographics, American Society of Anesthesiology (ASA) score as well as nature and type of pancreatico-digestive anastomosis. The rate of clinically relevant pancreatic fistula (36.8 % vs. 15.1%; P=0.050) and hospital s...
Obesity is Associated With Poor Surgical Outcome in
2013
Published data suggest a link between obesity and adverse outcomes in Crohn's disease (CD). We aimed to test the hypothesis that obese CD patients would be more likely than nonobese CD patients to have poor surgical outcome when undergoing surgery for a complication of CD.
Limitations of body mass index as an obesity measure of perioperative risk
British Journal of Anaesthesia, 2016
Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation. Anesth Analg 2011; 112: 602-7 17. Tachibana N, Niiyama Y, Yamakage M. Incidence of cannot intubate-cannot ventilate (CICV): results of a 3-year retrospective multicenter clinical study in a network of university hospitals.
Preoperative weight gain might increase risk of gastric bypass surgery
Surgery for Obesity and Related Diseases, 2011
Background-Weight loss improves the cardiovascular and metabolic risk associated with obesity. However, insufficient data are available about the health effects of weight gain, separate from the obesity itself. We sought to determine whether the changes in body weight before open gastric bypass surgery (OGB) would have a significant effect on the immediate perioperative hospital course. Methods-A retrospective chart review of 100 consecutive patients was performed to examine the effects of co-morbidities and body weight changes in the immediate preoperative period on the hospital length of stay and the rate of admission to the surgical intensive care unit (SICU). Results-Of our class III obese patients undergoing OGB, 95% had ≥1 co-morbid condition and an overall SICU admission rate of 18%. Compared with the patients with no perioperative SICU admission, the patients admitted to the SICU had a greater degree of insulin resistance (homeostatic model analysis-insulin resistance 10.8 ± 1.3 versus 5.9 ± 0.5, P = .001), greater serum triglyceride levels (225 ± 47 versus 143 ± 8 mg/dL, P = .003), and had gained more weight preoperatively (.52 ± .13 versus .06 ± .06 lb/wk, P = .003). The multivariate analyses showed that preoperative weight gain was a risk factor for a longer length of stay and more SICU admissions lasting ≥3 days, as were a diagnosis of sleep apnea and an elevated serum triglyceride concentration. Conclusion-The results of the present retrospective study suggest that weight gain increases the risk of perioperative SICU admission associated with OGB, independent of the body mass index. Sleep apnea and elevated serum triglyceride levels were also important determinants of perioperative morbidity. In view of the increasing epidemic of obesity and the popularity of bariatric surgical procedures, we propose that additional clinical and metabolic research focusing on the understanding of the complex relationship among obesity, positive energy balance, weight gain, and perioperative morbidity is needed.
Surgery for Obesity and Related Diseases, 2016
The importance of the Edmonton Obesity Staging System in predicting postoperative outcome and 30-day mortality after metabolic surgery Manuscript type: original contribution Running head: EOSS for postoperative outcome and 30-day mortality BACKGROUND: The Edmonton Obesity Staging System (EOSS) is a more comprehensive measure of obesity-related diseases and predictor of mortality than body mass index (BMI) or waist circumference. Its application for the selection of obese patients for obesity surgery has been suggested. OBJECTIVES: The aim of this study was to determine whether the EOSS can also be used in predicting postoperative outcome and 30-day mortality after metabolic surgery. METHODS: We collected data prospectively for patients undergoing laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), or laparoscopic omega-loop gastric bypass (LOLGB). The data collected included preoperative EOSS score, gender, age, BMI, waist circumference, waist-to-hip ratio, comorbidities, early postoperative complications, and 30-day mortality. SETTING: Center of maximum care in Germany RESULTS: A total of 534 patients were included. The mean BMI was 45.57 kg/m 2 (range 35-64.5) for LRYGB patients (n = 168), 53.27 kg/m 2 (range 35.1-82.1) for LSG patients (n = 282), and 49.42 kg/m 2 (range 36-73.1) for LOLGB patients (n = 84). The total postoperative complication rate was 8.99%. The most common EOSS stage was 2 (70.6% of patients), followed by stages 3 (12.55%), 1 (11.61%), and 0 (5.06%). The postoperative complication rates after LRYGB, LSG, and LOLGB were 0% for EOSS 0 and 1.61% for EOSS 1. The postoperative complication rates were 8.22% for EOSS 2 and 22.39% for EOSS 3. CONCLUSIONS: Patients with EOSS ≥ 3 have a higher risk of postoperative complications. Our data confirm that the EOSS is useful as a scoring system for the selection of obese patients before surgery and suggest that it may also be useful for presurgical stratification and risk assessment in clinical practice. Patients should be recommended for obesity surgery when their EOSS stage is 2 to prevent impairments associated with metabolic disease and to reduce the risk of postoperative complications.
Obesity Surgery Mortality Risk Score: Can we Go Beyond Mortality Prediction?
Journal of Anesthesia & Clinical Research, 2015
Introduction: High morbidity and low mortality has been linked to bariatric surgery. The Obesity surgery mortality risk score (OS-MRS) is a validated scale for mortality risk assessment. The aim of this study was to evaluate if OS-MRS scale can also be used as a predictor of postoperative complications in obese patients submitted to primary laparoscopic gastric bypass. Methods: Retrospective study including all patients submitted to primary laparoscopic gastric bypass between January and December 2014. The OS-MRS scale was applied preoperatively, and postoperative to access morbidity and mortality at 30 and 90 days. Complications were classified according to Clavien-Dindo's grades (I to V). The association between different OSMRS classes and the occurrence of adverse events was analyzed. Results: 85 patients were included and classified as class A (n=33; 38.8%), class B (n=48; 56.5%) and class C (n=4; 4.7%). No mortality cases were registered. The morbidity rate at 30 days was 23.5% (n=20), and 25.9% at 90 days (n=22). The complications rate in each of OS-MRS subgroups, was 9.1% in class A (both at 30 and 90 days), 31.3% and 35.4% in class B (at 30 and 90 days respectively), and 50% in class C (both at 30 and 90 days). There was a statistically significant independent relationship between OS-MRS scale, ASA physical status and the risk of developing pulmonary embolism, both at 30 and 90 postoperative days. Patients from classes B and C showed a greater risk of complications when compared to class A (at 30 days, OR 4.9, 95% IC: 1.3-18.2; p=0.019 and at 90 days, OR 5.8, 95% IC: 1.5-21.4; p=0.009). Conclusion: There is increasing evidence that OS-MRS scale is a useful tool to predict morbidity after gastric laparoscopic bypass in morbidly obese patients.
Effects of Obesity on Mortality and Morbidity in High-Risk Open Heart Surgery Patients
Annals of cardiology and vascular medicine, 2021
Background: The results of studies on the effect of obesity on mortality and morbidity in cardiac surgery are limited and contradictory. Today, the population of patients referred for open heart surgery is changing, and high-risk patients now represent a significant proportion of surgical candidates. In this study, the effect of obesity on mortality and morbidity in high risk patients in cardiac surgery was investigated retrospectively. Methods: This study was carried out by retrospectively evaluating the data of patients who had undergone adult Open Heart Surgery (OHS) in a university hospital operating room in the last 5 years (2015-2020). A total of 924 patients were examined in the study. The current online version of EuroSCORE (www.euroscore.org) was used and was calculated separately for all patients. The information in the hospital data system, preoperative evaluation forms, anesthesia follow-up slips, perfusion cards and intensive care, nurse follow-up forms of the patients (n = 95) calculated as EuroSCORE ≥ 6 were examined. The patients were divided into two groups as obese (body mass index (BMI) ≥ 30kg / m²) and non-obese (BMI <30kg / m²). Results: In the preoperative data, patients with diabetes mellitus in the obese group were statistically higher than the non-obese group (p=0.018). Mortality rate did not differ according to the groups (p> 0.05). Conclusion: In this study, no additional negative risk of obesity, which is considered to be an important risk factor for heart diseases, on cardiac surgery was determined.