The Impact of BMI on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes

2021 ◽  
Author(s):  
Iqra Sheikh ◽  
Kylie A Fuller ◽  
Kateena Addae-Konadu ◽  
Sarah Dotters-Katz ◽  
Megan Varvoutis
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Secondary Analysis ◽  
Wound Complication ◽  
Infectious Complications ◽  
Wound Complications ◽  
Maternal Fetal Medicine ◽  
Infectious Morbidity ◽  
Increased Risk ◽  
The Impact

Background As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. Study Design The present study is a secondary analysis of women who underwent cesarean delivery and had BMI > 40 kg/m2 in the Maternal Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9kg/m2, 50-59.9kg/m2, 60-69.9kg/m2, and >70kg/m2). Results Rates of postpartum infectious morbidity increased with BMI category (11.7% body mass index 50-59.9 kg/m2; 13.7% BMI 60-69.9 kg/m2, 21.9%; and BMI >70+ kg/m2; p=0.001). Readmission for wound complications also increased with BMI (3.1% for BMI 50-59.9 kg/m2; 6.2% for BMI 60-69.9 kg/m2; and 9.4% for BMI >70+kg/m2; p=0.001). After adjusting for confounders, increased BMI 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared to women with BMI 40-49.9 kg/m2 (aOR 6.38; 95% CI 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR 2.33 (95%CI 1.35-4.02) BMI 50-59.9kg/m2, aOR 4.91 (95% CI 2.07-11.7) BMI 60-69.9kg/m2, aOR 36.2 (7.45-176) for BMI >70kg/m2). Conclusion Women with BMI 50-70+kg/m2 are at an increased risk of postpartum wound infections and complications compared to women with BMI 40-49.9kg/m2. These data provide increased guidance for counseling women with an extremely elevated body mass index and highlight the importance of postpartum wound prevention bundles.

Association of Treatment of Chorioamnionitis with Non-Beta Lactam Antibiotics and Postcesarean Infectious Morbidity

2019 ◽  
Vol 37 (05) ◽  
pp. 461-466
Author(s):  
Angelica V. Glover ◽  
Ashley N. Battarbee ◽  
Robert Phillips Heine ◽  
Sarah Dotters-Katz
Keyword(s):  
Primary Outcome ◽  
Wound Complication ◽  
Pelvic Abscess ◽  
Wound Complications ◽  
Beta Lactam ◽  
Postoperative Infections ◽  
Maternal Fetal Medicine ◽  
Infectious Morbidity ◽  
Beta Lactam Antibiotics ◽  
Increased Risk

Abstract Objective Chorioamnionitis (CAM) is associated with postcesarean (CS) infectious morbidity (IM). Beta-lactam antibiotics (BLA) are used to treat CAM. It is uncertain if women who cannot receive BLA attain similar benefit from treatment of CAM with non-BLA. Study Design Retrospective cohort of women with CAM is delivered by CS in the maternal-fetal medicine units CS registry. We compared IM in women who received BLA versus women who received non-BLA. The primary outcome was a composite of endometritis, wound complication, necrotizing fasciitis, septic pelvic thrombophlebitis, and pelvic abscess. Multivariable logistic regression estimated odds ratios for the association of non-BLA treatment with IM outcomes. Results A total of 3,063 (93%) women received BLA, and 232 (7%) received non-BLA. Groups had similar rates of composite post-CS IM (10.6 vs. 12.1%, p = 0.5). After adjusting for confounders, treatment of CAM with non-BLA was not associated with post-CS IM (adjusted odds ratio [AOR] 1.1, 95% confidence interval [CI] 0.6–1.7), endometritis (AOR 1.1, 95% CI 0.7–1.8), or wound complications (AOR 1.2, 95% CI 0.5–3.2). Conclusion Women with CAM who receive non-BLA and require CS may not be at increased risk of postoperative infections complications, compared to women who receive BLA.

scholarly journals Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index: a nationwide population-based study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
So-Ryoung Lee ◽  
Kyung-Do Han ◽  
Eue-Keun Choi ◽  
Seil Oh ◽  
Gregory Y. H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Body Mass ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Increased Risk ◽  
The Impact

AbstractWe evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: < 30, 30 to < 60, and ≥ 60. During a median 8-year of follow-up, 534,442 subjects were newly diagnosed as AF (8.27 per 1000 person-years). Higher FLI was associated with an increased risk of AF (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.046–1.060 in 30 ≤ FLI < 60, and HR 1.115, 95% CI 1.106–1.125 in FLI ≥ 60). In underweight subjects (BMI < 18.5 kg/m2), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI < 60 and by twofold in FLI ≥ 60). In normal- and overweight subjects, higher FLI was associated with an increased risk of AF, but the HRs were attenuated. In obese subjects, higher FLI was not associated with higher risk of AF. NAFLD as assessed by FLI was independently associated with an increased risk of AF in nonobese subjects with BMI < 25 kg/m2. The impact of NAFLD on AF risk was accentuated in lean subjects with underweight.

The impact of body mass index dynamics on survival of patients with advanced pancreatic cancer receiving chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15066-e15066
Author(s):  
Younak Choi ◽  
Do-Youn Oh ◽  
Tae-Yong Kim ◽  
Kyung-Hun Lee ◽  
Sae-Won Han ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Clinical Characteristics ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
High Body Mass Index ◽  
Good Health ◽  
Increased Risk ◽  
The Impact

e15066 Background: The obesity is increasing worldwide. High body mass index (BMI) is linked with an increased risk of developing pancreatic cancer (PC). However, in patients with advanced PC (APC), especially those are receiving palliative chemotherapy (the majority of all PC patients), the impact of BMI and its change during disease course on survival has not been fully investigated. Methods: Consecutive patients with APC were enrolled during years 2003-2010, all treated with palliative chemotherapy. The BMI measured at the point of starting the first cycle of palliative chemotherapy was called as “BMI at diagnosis”. “Pre-cancer weight” which means the weight in good health was the sum of “weight at diagnosis” and “weight loss at diagnosis” that the patients’ self- reported at the first visit. “Pre-cancer BMI” was calculated using pre-cancer weight. We got weight data measured at every visit during chemotherapy to investigate BMI change during chemotherapy period. Clinical characteristics and outcomes were analyzed. Results: A total of 425 patients were enrolled (median age, 60.1 years). At diagnosis of APC, the BMI distribution of patients was as follows: <18.5 (45, 10.6%); 18.5-19.9 (67, 15.8%); 20.0-22.4 (156, 36.7%); 22.5-24.9 (107, 25.2%); 25.0-29.9 (49, 11.5%); and ≥30.0 (1, 0.2%). Clinical characteristics were balanced across BMI groups. Median overall survival (OS) was 8.1 months (95% CI, 7.2-9.1). Pre-cancer BMI and BMI at diagnosis had no impact on OS (p = 0.488, p = 0.348, respectively), although patients at BMI range of 22.5-24.9 achieved the longest OS (9.9 months; 95% CI, 8.5-11.3). BMI loss at diagnosis (pre-cancer BMI minus BMI at the diagnosis) and BMI loss during chemotherapy (both stipulated as BMI change ≥1) were associated with shortened OS (HR, 1.300; p = 0.012 and HR, 1.367; p= 0.010, respectively). Conclusions: In patients with APC undergoing palliative chemotherapy, both declines in BMI at diagnosis of APC and during chemotherapy are more hazardous for OS than pre-cancer BMI or BMI at diagnosis itself as absolute values. Further research evaluating strategies to maintain BMI during chemotherapy in this setting is thus warranted.

scholarly journals Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes

2019 ◽  
Author(s):  
Hayley Martin ◽  
Kelly Thevenet-Morrison ◽  
Ann Dozier
Keyword(s):  
Body Mass Index ◽  
Weight Gain ◽  
Body Mass ◽  
Exclusive Breastfeeding ◽  
Directed Acyclic Graphs ◽  
Pregnancy Weight Gain ◽  
Increased Risk ◽  
Breastfeeding Cessation ◽  
Pregnancy Weight ◽  
The Impact

Abstract BackgroundIt is well established that mothers with above-normal pre-pregnancy body mass index (BMI) are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain is less well-defined. Excess pregnancy weight-gain may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. C-section, gestational diabetes), and may make effective latch more difficult to achieve.MethodsOur objective was to determine the impact of pregnancy weight-gain and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N=1207). Pregnancy weight-gain category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of pregnancy weight-gain). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models.ResultsAfter adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended pregnancy weight-gain had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended pregnancy weight-gain were at increased risk of cessation, although not significantly (adjusted Hazard Ratio [95% CI]: 1.29 [0.95 – 1.75]). No significant relationship was observed for exclusive breastfeeding cessation. ConclusionPre-pregnancy BMI and pregnancy weight-gain may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

scholarly journals Managing overlapping surgery: an analysis of 1018 neurosurgical and spine cases

2017 ◽  
Vol 127 (5) ◽  
pp. 1096-1104 ◽  
Author(s):  
Jian Guan ◽  
Andrea A. Brock ◽  
Michael Karsy ◽  
William T. Couldwell ◽  
Meic H. Schmidt ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Secondary Outcome ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Increased Risk ◽  
Neurosurgical Patients ◽  
Physical Classification ◽  
The Impact ◽  
Surgery Duration

OBJECTIVEOverlapping surgery—the performance of parts of 2 or more surgical procedures at the same time by a single lead surgeon—has recently come under intense scrutiny, although data on the effects of overlapping procedures on patient outcomes are lacking. The authors examined the impact of overlapping surgery on complication rates in neurosurgical patients.METHODSThe authors conducted a retrospective review of consecutive nonemergent neurosurgical procedures performed during the period from May 12, 2014, to May 12, 2015, by any of 5 senior neurosurgeons at a single institution who were authorized to schedule overlapping cases. Overlapping surgery was defined as any case in which 2 patients under the care of a single lead surgeon were under anesthesia at the same time for any duration. Information on patient demographics, premorbid conditions, surgical variables, and postoperative course were collected and analyzed. Primary outcome was the occurrence of any complication from the beginning of surgery to 30 days after discharge. A secondary outcome was the occurrence of a serious complication—defined as a life-threatening or life-ending event—during this same period.RESULTSOne thousand eighteen patients met the inclusion criteria for the study. Of these patients, 475 (46.7%) underwent overlapping surgery. Two hundred seventy-one patients (26.6%) experienced 1 or more complications, with 134 (13.2%) suffering a serious complication. Fourteen patients in the cohort died, a rate of 1.4%. The overall complication rate was not significantly higher for overlapping cases than for nonoverlapping cases (26.3% vs 26.9%, p = 0.837), nor was the rate of serious complications (14.7% vs 11.8%, p = 0.168). After adjustments for surgery type, surgery duration, body mass index, American Society of Anesthesiologists (ASA) physical classification grade, and intraoperative blood loss, overlapping surgery remained unassociated with overall complications (OR 0.810, 95% CI 0.592–1.109, p = 0.189). Similarly, after adjustments for surgery type, surgery duration, body mass index, ASA grade, and neurological comorbidity, there was no association between overlapping surgery and serious complications (OR 0.979, 95% CI 0.661–1.449, p = 0.915).CONCLUSIONSIn this cohort, patients undergoing overlapping surgery did not have an increased risk for overall complications or serious complications. Although this finding suggests that overlapping surgery can be performed safely within the appropriate framework, further investigation is needed in other specialties and at other institutions.

scholarly journals The Effect of Smoking and Body Mass Index on The Complication Rate of Alloplastic Breast Reconstruction

2019 ◽  
Vol 109 (2) ◽  
pp. 143-150 ◽  
Author(s):  
N. Sadok ◽  
I. S. Krabbe-Timmerman ◽  
G. H. de Bock ◽  
P. M. N. Werker ◽  
L. Jansen
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Breast Reconstruction ◽  
Body Mass ◽  
Complication Rate ◽  
Consecutive Series ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
The Impact ◽  
Alloplastic Breast Reconstruction

Background and Aims:The aim of this study was to evaluate the effect of smoking and body mass index on the occurrence of complications after alloplastic breast reconstruction.Materials and Methods:A consecutive series of 56 patients treated with immediate or delayed alloplastic breast reconstruction, including six cases combined with latissimus dorsi flap, at three hospitals between 2012 and 2018 were included. Complications were scored and defined according to Clavien–Dindo. To evaluate the impact of smoking, body mass index, and other potential risk factors on the occurrence of any and severe complications, univariate and multivariate logistic regression analyses were applied to estimate odds ratios and 95% confidence intervals.Results:In 56 patients, 22 patients had a complication. As much as 46% of smokers had severe complications compared to 18% of non-smokers. Of patients with body mass index ⩾ 25, 40% had severe complications compared to 10% with body mass index < 25. Smokers had eight times more chance of developing severe complications than non-smokers (ORadjusted = 8.0, p = 0.02). Patients with body mass index ⩾ 25 had almost 10 times more severe complications compared to patients with body mass index ⩽ 25 (ORadjusted = 9.9, p = 0.009). No other risk factors were significant.Conclusion:Smoking and body mass index ⩾ 25 both increased the complication rate to such an extent that patients should be informed about their increased risk for complications following alloplastic breast reconstruction and on these grounds surgeons may delay alloplastic breast reconstruction. It is an ethical dilemma whether one should deny overweight and obese patients and those who smoke an immediate alloplastic breast reconstruction. For both life style interventions, adequate guidance should be made available.

scholarly journals Long-Term Burden of Increased Body Mass Index from Childhood on Adult Dyslipidemia: The i3C Consortium Study

2019 ◽  
Vol 8 (10) ◽  
pp. 1725 ◽  
Author(s):  
Yinkun Yan ◽  
Lydia A. Bazzano ◽  
Markus Juonala ◽  
Olli T. Raitakari ◽  
Jorma S. A. Viikari ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Early Life ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Lipid Levels ◽  
Increased Risk ◽  
The Impact

Background: Data are limited regarding the association of cumulative burden and trajectory of body mass index (BMI) from early life with adult lipid disorders. Methods: The study cohort consisted of 5195 adults who had BMI repeatedly measured 4 to 21 times from childhood and had blood lipid measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) and information on lipid-lowering medications in the last adult survey. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI. Results: Participants with dyslipidemia, high LDL-C, low HDL-C and high TG had consistently and significantly higher BMI levels from childhood to adulthood compared to those with normal lipid levels. After adjusting for age, race, sex, and cohort, increased risk of adult dyslipidemia was significantly associated with higher values of childhood BMI, adulthood BMI, total AUC and incremental AUC, with odds ratio (95% confidence interval) = 1.22 (1.15–1.29), 1.85 (1.74–1.97), 1.61 (1.52–1.71), and 1.59 (1.50–1.69), respectively, and p < 0.001 for all. The association patterns were similar in most race–sex subgroups. Conclusions: Adults with dyslipidemia versus normal lipid levels have consistently higher levels and distinct life-course trajectories of BMI, suggesting that the impact of excessive body weight on dyslipidemia originates in early life.

Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Boriani ◽  
M Proietti ◽  
C Laroche ◽  
L Fauchier ◽  
F Marin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Large Cohort ◽  
Funding Source ◽  
Increased Risk ◽  
Underweight Patients ◽  
The Impact

Abstract Introduction The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated. Aims To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients. Methods We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death. Results A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p&lt;0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p&lt;0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p&lt;0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p&lt;0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1). Conclusions In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death. Figure 1. Outcomes at 1-year Follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants

scholarly journals Long-term body mass index changes in obese adults and the risk of heart failure, cardiovascular disease and mortality: a longitudinal study of 260,000 adults

2020 ◽  
Author(s):  
Barbara Iyen ◽  
Stephen Weng ◽  
Yana Vinogradova ◽  
Ralph Akyea ◽  
Nadeem Qureshi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Body Mass ◽  
World Health ◽  
Obese Adults ◽  
Increased Risk ◽  
Bmi Trajectories ◽  
The Impact

Abstract Background: Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified. Methods: This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes. Results: 264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8kg/m 2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06kg/m 2 (± 3.8)). Compared with overweight individuals, class-3 obese individuals had a 3.3-fold increased risk of heart failure (HR 3.26 (95% CI 2.98-3.57)), 2.7-fold increased risk of all-cause mortality (HR 2.72 (2.58-2.87)) and 3.3-fold increased risk of CVD-related mortality (HR 3.31 (2.84-3.86)) after adjusting for baseline demographic and cardiovascular risk factors. Conclusion: The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.

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