Does Elective Sternal Plating in Morbidly Obese Patients Reduce Sternal Complication Rates?

: The rising pandemic of obesity in modern society should direct attention to a more comprehensive approach to abdominal aortic aneurysm (AAA) treatment in the affected population. Although overweight patients are considered prone to increased surgical risk, studies on the subject did not confirm or specify the risks well enough. : Associated comorbidities inevitably lead to a selection bias leaning towards endovascular abdominal aortic repair (EVAR), as a less invasive treatment option, which makes it hard to single out obesity as an independent risk factor. The increased technical difficulty often results in prolonged procedure times and increased blood loss. Several smaller studies and two analyses of national registries, including 7935 patients, highlighted the advantages of EVAR over open repair (OR) of abdominal aortic aneurysm, especially in morbidly obese population (relative risk reduction up to 47%). On the other hand, two other studies with 1374 patients combined, concluded that EVAR might not have an advantage over OR in obese patients (P = 0.52). Obesity is an established risk factor for wound infection after both EVAR and OR, which is associated with longer length of stay, subsequent major operations, and a higher rate of graft failure. Percutaneous EVAR technique could present a promising solution to reducing this complication. : EVAR seems like a more feasible treatment option than OR for obese patients with AAA, due to lower overall morbidity and mortality rates, as well as reduced wound-related complication rates. However, there is a clear lack of high-quality evidence on the subject, thus future prospective trials are needed to confirm this advantage.

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The Role of BMI in Hip Fracture Surgery

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517747414 ◽

2018 ◽

Vol 9 ◽

pp. 215145851774741 ◽

Cited By ~ 15

Author(s):

Sheriff D. Akinleye ◽

Garret Garofolo ◽

Maya Deza Culbertson ◽

Peter Homel ◽

Orry Erez

Keyword(s):

Hip Fracture ◽

Protective Factor ◽

Morbidly Obese ◽

Complication Rates ◽

Obese Patients ◽

Surgical Morbidity ◽

Improvement Program ◽

Hip Fracture Surgery ◽

Low Weight ◽

Fracture Surgery

Introduction: Obesity is an oft-cited cause of surgical morbidity and many institutions require extensive supplementary screening for obese patients prior to surgical intervention. However, in the elderly patients, obesity has been described as a protective factor. This article set out to examine the effect of body mass index (BMI) on outcomes and morbidity after hip fracture surgery. Methods: The National Surgical Quality Improvement Program database was queried for all patients undergoing 1 of 4 surgical procedures to manage hip fracture between 2008 and 2012. Patient demographics, BMI, and known factors that lead to poor surgical outcomes were included as putative predictors for complications that included infectious, cardiac, pulmonary, renal, and neurovascular events. Using χ2 tests, 30-day postoperative complication rates were compared between 4 patient groups stratified by BMI as low weight (BMI < 20), normal (BMI = 20-30), obese (BMI = 30-40), and morbidly obese (BMI > 40). Results: A total of 15 108 patients underwent surgery for hip fracture over the examined 5-year period. Of these, 18% were low weight (BMI < 20), 67% were normal weight (BMI = 20-30), 13% were obese (BMI = 30-40), and 2% were morbidly obese (BMI > 40). The low-weight and morbidly obese patients had both the highest mortality rates and the lowest superficial infection rates. There was a significant increase in blood transfusion rates that decreased linearly with increasing BMI. Deep surgical site infection and renal failure increased linearly with increasing BMI, however, these outcomes were confounded by comorbidities. Conclusion: This study demonstrates that patients at either extreme of the BMI spectrum, rather than solely the obese, are at greatest risk of major adverse events following hip fracture surgery. This runs contrary to the notion that obese hip fracture patients automatically require additional preoperative screening and perioperative services, as currently implemented in many institutions.

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Feasibility of primary sternal plating for morbidly obese patients after cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0841-y ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Joshua M. Liao ◽

Patrick Chan ◽

Lorraine Cornwell ◽

Peter I. Tsai ◽

Joseph H. Joo ◽

...

Keyword(s):

Cardiac Surgery ◽

Morbidly Obese ◽

Obese Patients ◽

Sternal Plating

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Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients

Scientific Reports ◽

10.1038/s41598-021-02999-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yeshong Park ◽

Young Suk Park ◽

Sangjun Lee ◽

So Hyun Kang ◽

Eunju Lee ◽

...

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Single Port ◽

Morbidly Obese ◽

Complication Rates ◽

Obese Patients ◽

Significant Difference ◽

Reduced Port ◽

One Year

AbstractLaparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.

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Does Body Mass Index Cause a Clinical Difference in Simultaneous Bilateral and Unilateral Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0040-1702932 ◽

2020 ◽

Author(s):

Hasan Ulas Ogur ◽

Hakan Cicek ◽

Fırat Seyfettinoglu ◽

Ümit Tuhanioglu ◽

Ali Aydoğdu ◽

...

Keyword(s):

Postoperative Complications ◽

Knee Arthroplasty ◽

Morbidly Obese ◽

Moderate Increase ◽

Complication Rates ◽

Obese Patients ◽

Early Postoperative Complications ◽

Clinical Scores ◽

Clinical Difference ◽

Simultaneous Bilateral Tka

AbstractThis study aims to investigate clinical and functional factors in patients undergoing unilateral and simultaneous bilateral total knee arthroplasty (TKA) who were classified into subgroups of nonobese, obese, and morbidly obese, and to determine perioperative and postoperative complications. We conducted an evaluation of 489 nonobese, obese, and morbidly obese patients who underwent TKA due to primary knee osteoarthritis between January 2006 and December 2013. The arthroplasties were performed by three different surgeons. Patients who underwent unilateral (group 1) or simultaneous bilateral (group 2) TKAs were divided into subgroups in accordance with BMI levels, that is, (a) nonobese (BMI < 30 kg/m2), (b) obese (BMI = 30–34.9 kg/m2), and (c) morbidly obese (BMI ≥35 kg/m2). Clinical and functional assessments were performed using Knee Society Scores (KSSs), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and range of motion (ROM) values. Perioperative and early postoperative complications were assessed. The mean follow-up period was 46.65 months (minimum: 24 months; maximum: 84 months). There were no significant differences between the patients undergoing unilateral or simultaneous bilateral TKA procedures regarding postoperative ROM, WOMAC indices, and KSSs (p > 0.05), except for morbidly obese patients. Most intraoperative and early postoperative complications occurred in the morbidly obese group, especially in those undergoing simultaneous bilateral TKA procedures (p < 0.001). Unilateral and simultaneous bilateral TKA procedures showed no differences regarding ROM, clinical scores, and perioperative and early postoperative complications in nonobese and obese patients. A moderate increase was detected in complication rates in the unilateral TKA morbidly obese patients (group 1c); however, morbidly obese patients constituted the major risk group in simultaneous bilateral TKA patients (group 2c) regarding clinical scores (lower WOMAC scores and KSSs) and the development of complications.

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TOTALLY TUBELESS PERCUTANEOUS NEPHROLITHOTOMY (PCNL) : IS IT FEASIBLE IN MORBIDLY OBESE PATIENTS?

10.36106/gjra/6303447 ◽

2020 ◽

pp. 1-2

Author(s):

Rahul Goel

Keyword(s):

Normal Activity ◽

Morbidly Obese ◽

Transfusion Rate ◽

Complication Rates ◽

Obese Patients ◽

Increased Risk ◽

Group 2 ◽

Time Of Admission ◽

Analgesic Use ◽

Free Status

Purpose- PCNL is difficult in obese, and has increased risk of peri-operative complications in obese ,it was decided to retrospectively analyse from our patients, of last 8 yrs, to determine stone free status and complication rates. Material and Methods- Study was between January 2011- January 2019 , 78 morbidly obese patients were randomised, with body mass index over 35 who had indication of PCNL , stones larger than 2 cms and stones smaller in size and treatment unfit for ESWL (extra corporeal shock wave lithotripsy) if stone skin difference was high, or ESWL resistant hard stones were enrolled. Patients randomly assigned in two groups, Group 1 standard PCNL with Nephrostomy and a Stent ,Group 2 Totally tubeless with no Nephrostomy and no Stent, and the outcomes were compared. Results- The transfusion rate, operative time and the drop in hemoglobin were same in both groups (p>0.05). Total analgesic use was equivalent of 33.8 vs 14.7 mgs of morphine sulfate (18-77mg) and was significantly lower in tubeless group(p=0.001). Return to normal was described as total number of in-patients and outpatients days from time of admission to the point which the patient returns to normal activity such as going to job and was 19.4 vs 9.3 days (6-30 days, p=0.001) Conclusion- Totally tubeless PCNL in obese patients had lower analgesic use and return to normal activity vs standard PCNL. Totally tube less PCNL is recommended for obese patients.

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The Feasibility of Laparoscopic Surgery in Gynecologic Oncology for Obese and Morbidly Obese Patients

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001260 ◽

2018 ◽

Vol 28 (5) ◽

pp. 967-974 ◽

Cited By ~ 6

Author(s):

Jessie Peng ◽

Sarah Sinasac ◽

Katherine J. Pulman ◽

Liying Zhang ◽

Joan Murphy ◽

...

Keyword(s):

Robotic Surgery ◽

Average Length ◽

Gynecologic Oncology ◽

Pelvic Surgery ◽

Group Differences ◽

Morbidly Obese ◽

Fisher Exact Test ◽

Complication Rates ◽

Obese Patients ◽

Significant Difference

BackgroundSurgical interventions are the mainstay of treatment for many gynecological cancers. Although minimally invasive surgery offers many potential advantages, performing laparoscopic pelvic surgery in obese patients remains challenging. To overcome this, many centers have shifted their practice to robotic surgery; however, the high costs associated with robotic surgery are concerning and limit its use.ObjectiveThis study aimed to examine the feasibility of performing laparoscopic gynecologic oncology procedures in obese and morbidly obese patients.Materials and MethodsThis retrospective study evaluated patients who underwent laparoscopic surgeries by a gynecologic oncologist from January 2012 to June 2016 at a designated gynecologic oncology center. Patients were categorized as nonobese (body mass index [BMI] < 30 kg/m2), obese (BMI 30–39.9 kg/m2), and morbidly obese (BMI ≥ 40 kg/m2). Intra and postoperative complications and outcomes were recorded. Group differences were computed with Kruskal-Wallis nonparametric test (continuous) or Fisher exact test (categorical).ResultsOf 497 patients, 288 were nonobese (58%), 162 obese (33%), and 47 morbidly obese (9%). Complex surgical procedures were performed in 57.4% of obese patients and 55.3% of morbidly obese patients. Although morbidly obese and obese patients had longer operative times (mean of 181 and 166 minutes vs 144 minutes,P= 0.014), conversion from laparoscopy to laparotomy occurred in 9.05% of all patients, with no group differences. Low intraoperative (9%–11%) and severe postoperative (2.41%) complication rates were observed overall, with no group differences. There was no statistically significant difference in the rate of emergency room visits 30 days postoperation between the 3 BMI groups (P= 0.6108). Average length of postoperative stay was statistically significant (P= 0.0003) but was low overall (1–2 days). Hospital readmission rates were low, with the lowest rate among morbidly obese patients (2.13%).ConclusionsOur data suggest that laparoscopic gynecologic-oncology procedures for obese patients are feasible and safe.

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