Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery

AbstractThe objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center. Patients were included if there was a plan for potential surgical repair/reconstruction of two or more ligaments. Patients with prior surgery to the affected knee or intra-articular fracture requiring reduction and fixation were excluded. Comparisons between obese and nonobese patients were made using two-sample t-test and either chi-square or Fisher's exact test for continuous and categorical variables, respectively. Significance was set at p < 0.05. Of 108 patients meeting inclusion criteria, 83 had BMI < 35 kg/m2 and 25 had BMI ≥ 35 kg/m2. Obese patients sustained higher rates of MLKI due to ultralow velocity mechanisms (28.0 vs. 1.2%; p = 0.0001) and higher rates of concomitant lateral meniscus injury (48.0 vs. 25.3%; p = 0.04). Among patients undergoing single-staged surgery, obese patients had significantly longer duration of surgery (219.8 vs. 178.6 minutes; p = 0.02) and more wound infections requiring I&D (20.0 vs. 4.8%; p = 0.03). In contrast, nonobese patients had higher rates of arthrofibrosis requiring manipulation under anesthesia and/or arthrolysis (25.3 vs. 0%; p = 0.003). Obese patients undergoing surgery of an MLKI have longer operative times, greater rates of wound infection requiring I&D, and lower rates of arthrofibrosis. Surgeons may consider these results when counseling patients on their postoperative course and risk for complications. Future research might focus on strategies to reduce complication rates in obese patients with MLKI. This is a Level III, retrospective comparative study.

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Comparing Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Obese and Nonobese Patients: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-113445/v1 ◽

2020 ◽

Author(s):

Xiaoxiong Huang ◽

Wanjin Qin ◽

Huilin Yang ◽

Minjie Shen

Keyword(s):

Visual Analog Scale ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Visual Analog Scale Score ◽

Transforaminal Lumbar Interbody Fusion ◽

Obese Patients ◽

Analog Scale ◽

Estimated Blood Loss ◽

Duration Of Surgery ◽

Nonobese Patients

Abstract Background: Our study aimed to compare the outcomes of obese and nonobese patients following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Methods: Relevant studies comparing the outcome of MIS-TLIF between obese and nonobese patients were involved to make a systematic literature review and meta-analysis. All of the comparative studies published in PubMed, MEDLINE, and Web of Science databases as recently as 10 July 2020, were included. Primary outcomes (complications) and secondary outcomes (Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, the length of hospital stay, the duration of surgery, and the estimated blood loss) were assessed between obese patients and nonobese patients. Statistical analysis was performed by Review Manager 5.3 and forest plots were made for each outcome.Results: Nine studies were enrolled in this meta-analysis. BMI correlated significantly with complications, and postoperative complications occurred more frequently in obese patients. Additionally, obese patients after MIS-TLIF were associated with similar Oswestry Disability Index (ODI) score, Visual Analog Scale score for back pain(BP-VAS), and Visual Analog Scale score for leg pain(LP-VAS) scores in early (≤6 months after MIS-TLIF) and late period (≥24 months after MIS-TLIF). There was no significant difference in intraoperative complications, duration of surgery, length of hospital stay, and estimated blood loss between the two groups.Conclusion: Obese patients should not be excluded from MIS-TLIF procedures due to worry about higher postoperative complication rates. Understanding common postoperative complications after MIS-TLIF will improve the treatment of obese patients with the degenerative lumbar disease.

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Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries

Journal of Neurosurgery Spine ◽

10.3171/2021.1.spine201785 ◽

2021 ◽

pp. 1-11

Author(s):

Austin H. Carroll ◽

Ehsan Dowlati ◽

Esteban Molina ◽

David Zhao ◽

Marcelle Altshuler ◽

...

Keyword(s):

Minimally Invasive ◽

Retrospective Review ◽

Operative Time ◽

Secondary Outcome ◽

Complication Rates ◽

Open Approach ◽

Obese Patients ◽

Lumbar Surgery ◽

Estimated Blood Loss ◽

Nonobese Patients

OBJECTIVE The effect of obesity on outcomes in minimally invasive surgery (MIS) approaches to posterior lumbar surgery is not well characterized. The authors aimed to determine if there was a difference in operative variables and complication rates in obese patients who underwent MIS versus open approaches in posterior spinal surgery, as well as between obese and nonobese patients undergoing MIS approaches. METHODS A retrospective review of all consecutive patients who underwent posterior lumbar surgery from 2013 to 2016 at a single institution was performed. The primary outcome measure was postoperative complications. Secondary outcome measures included estimated blood loss (EBL), operative time, the need for revision, and hospital length of stay (LOS); readmission and disposition were also reviewed. Obese patients who underwent MIS were compared with those who underwent an open approach. Additionally, obese patients who underwent an MIS approach were compared with nonobese patients. Bivariate and multivariate analyses were carried out between the groups. RESULTS In total, 423 obese patients (57.0% decompression and 43.0% fusion) underwent posterior lumbar MIS. When compared with 229 obese patients (56.8% decompression and 43.2% fusion) who underwent an open approach, patients in both the obese and nonobese groups who underwent MIS experienced significantly decreased EBL, LOS, operative time, and surgical site infections (SSIs). Of the nonobese patients, 538 (58.4% decompression and 41.6% fusion) underwent MIS procedures. When compared with nonobese patients, obese patients who underwent MIS procedures had significantly increased LOS, EBL, operative time, revision rates, complications, and readmissions in the decompression group. In the fusion group, only LOS and disposition were significantly different. CONCLUSIONS Obese patients have poorer outcomes after posterior lumbar MIS when compared with nonobese patients. The use of an MIS technique can be of benefit, as it decreased EBL, operative time, LOS, and SSIs for posterior decompression with or without instrumented fusion in obese patients.

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Do Obese Breast Cancer Patients Have More Complications and a Longer Length of Stay After Mastectomy Than Nonobese Patients?

The American Surgeon ◽

10.1177/0003134820973352 ◽

2020 ◽

pp. 000313482097335

Author(s):

Melinda Wang ◽

Julian Huang ◽

Anees B. Chagpar

Keyword(s):

Breast Cancer ◽

Length Of Stay ◽

Cancer Patients ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Wound Complications ◽

Complication Rates ◽

Obese Patients ◽

Breast Cancer Patients ◽

Nonobese Patients

Background While obesity is thought to increase complication rates in general surgery procedures, its effect in mastectomy patients remains to be fully elucidated. We sought to determine if obesity is associated with a higher complication rate and length of stay after mastectomy, independent of clinicopathologic and treatment factors. Methods Medical records of breast cancer patients undergoing mastectomy at our institution between January 2010 and December 2017 were retrospectively reviewed. Patients were separated into obese (body mass index [BMI] ≥ 30) and nonobese (BMI < 30) categories and compared using nonparametric statistical analyses. Results Of 927 patients, 291 (31.2%) were obese. Obese patients had more complications (26.5% vs. 20.0%, P = 0.033) and a greater number of complications per patient ( P = 0.025) than nonobese patients. They were more likely to have infections (10.7% vs. 5.7%, P = .009), flap thrombosis/necrosis (5.5% vs. 2.4%, P = .018), and skin breakdown/wound complications (8.6% vs. 4.6%, P = .022). Additionally, obese patients had longer hospital length of stay (LOS; LOS > 2 days: 77.7% vs. 65.2%, P < .001). Controlling for potential confounders, obesity remained associated with a higher rate of thrombosis/necrosis of flap (odds ratio [OR] = 2.26; 95% confidence interval [CI] 1.01-5.08; P = .047) and LOS ≥ 2 days (OR = 1.82; 95% CI 1.23-2.69; P = .003). Conclusion Obese breast cancer patients undergoing mastectomy have more thrombosis/necrosis of flap and a longer hospital LOS than nonobese patients, regardless of other comorbidities and clinicopathologic/treatment factors.

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Obesity Does Not Increase Mortality after Emergency Surgery

Journal of Obesity ◽

10.1155/2014/492127 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

Paula Ferrada ◽

Rahul J. Anand ◽

Ajai Malhotra ◽

Michel Aboutanos

Keyword(s):

Wound Infection ◽

Emergency Surgery ◽

Significant Risk ◽

Significant Risk Factor ◽

Patient Characteristics ◽

Obese Patients ◽

Exact Test ◽

Icu Admission ◽

Nonobese Patients ◽

The Impact

Objective.The aim of this study is to evaluate the impact of obesity on patient outcomes after emergency surgery.Methods.A list of all patients undergoing emergent general surgical procedures during the 12 months ending in July 2012 was obtained from the operating room log. A chart review was performed to obtain the following data: patient characteristics (age, gender, BMI, and preexisting comorbidities), indication for surgery, and outcomes (pulmonary embolus (PE), deep venous thrombosis (DVT), respiratory failure, ICU admission, wound infection, pneumonia, and mortality). Obesity was defined as a BMI over 25. Comparisons of outcomes between obese and nonobese patients were evaluated using Fischer’s exact test. Predictors of mortality were evaluated using logistic regression.Results.341 patients were identified during the study period. 202 (59%) were obese. Both groups were similar in age (48 for obese versus 47 for nonobese,P=0.42). Obese patients had an increased incidence of diabetes, (27% versus 7%,P<0.05), hypertension (52% versus 34%,P<0.05), and sleep apnea (0% versus 5%,P<0.05). There was a statistically significant increased incidence of postoperative wound infection (obese 9.9% versus nonobese 4.3%,P<0.05) and ICU admission (obese 58% versus nonobese 42%,P=0.01) among the obese patients. Obesity alone was not shown to be a significant risk factor for mortality.Conclusions.A higher BMI is not an independent predictor of mortality after emergency surgery. Obese patients are at a higher risk of developing wound infections and requiring ICU admission after emergent general surgical procedure.

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The Rise of Obesity among Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1710566 ◽

2020 ◽

Author(s):

Nequesha S. Mohamed ◽

Wayne A. Wilkie ◽

Ethan A. Remily ◽

Iciar M. Dávila Castrodad ◽

Mirlande Jean-Pierre ◽

...

Keyword(s):

Morbid Obesity ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

National Database ◽

Categorical Variables ◽

Morbidly Obese ◽

Obese Patients ◽

Total Knee ◽

Nonobese Patients

AbstractIn the United States, one-third of adults are considered obese, and demand for total knee arthroplasty (TKA) is expected to rise in these patients. Surgeons are reluctant to operate on obese patients, but it is important to understand how obesity has affected TKA utilization. This study utilizes a national database to evaluate incidence, demographics, outcomes, charges, and cost in nonobese, overweight, nonmorbidly obese, and morbidly obese TKA patients. We queried the National Inpatient Sample from 2009 to 2016 for primary TKA patients identifying 4,053,037 nonobese patients, 40,077 overweight patients, 809,649 nonmorbidly obese patients, and 428,647 morbidly obese patients. Chi-square was used to analyze categorical variables, and one-way analysis of variance was used to analyze continuous variables. Nonmorbidly obese and morbidly obese patients represented 23.2% of all TKAs. TKA utilization increased 4.1% for nonobese patients, 121.6% for overweight patients, 73.6% for nonmorbidly obese patients, and 83.9% for morbidly obese patients. Morbidly obese patients were younger (p < 0.001), female (p < 0.001), Black (p < 0.001), poor (p < 0.001), and utilized private insurance (p < 0.001). They also had the longest length of stay (p < 0.001) and the highest mortality rate (p < 0.001). More morbidly obese patients were discharged to other facilities (p < 0.001), and they had the highest rate of complications (p < 0.001). Patients with morbid obesity had the highest charges (p < 0.001), but overweight patients had the highest costs (p < 0.001). The results of this study demonstrate the rise in obese and morbidly obese patients seeking TKAs, which may be reflection of the obesity epidemic in America. Although TKA utilization has increased for morbidly obese patients, this body mass index (BMI) category also has the highest rates of charges and complications, suggesting morbid obesity to be a modifiable risk factor leading to worse surgical and economic outcomes. Obese patients undergoing TKA may benefit from preoperative optimization of their weight, in an effort to reduce the risk of adverse outcomes.

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Obesity Does Not Impact Outcomes for Appendicitis

The American Surgeon ◽

10.1177/000313481207800248 ◽

2012 ◽

Vol 78 (2) ◽

pp. 254-257 ◽

Cited By ~ 4

Author(s):

Daniel A. DeUgarte ◽

Rebecca Stark ◽

Amy H. Kaji ◽

Arezou Yaghoubian ◽

Amy Tolan ◽

...

Keyword(s):

Length Of Stay ◽

Univariate Analysis ◽

Laparoscopic Approach ◽

Infectious Complications ◽

Complication Rates ◽

Obese Patients ◽

Lower Complication ◽

Abstract Data ◽

Nonobese Patients ◽

The Impact

Obesity has long been considered a risk factor for surgery. The purpose of this study was to evaluate the impact of obesity on outcomes after appendectomy. A retrospective study was performed using discharge abstract data obtained from patients with documented body mass index (BMI) undergoing appendectomy for appendicitis (n = 2919). Complications and length of stay for different BMI categories were compared. Obese patients (BMI > 30 kg/m2) had similar rates of perforation (20%) and were as likely to undergo a laparoscopic approach (85%) as nonobese patients. On multivariable and univariate analysis, no significant differences were observed when comparing obese and nonobese patients for the outcomes of length of stay, infectious complications, and need for readmission. On multivariate analysis, laparoscopy predicted lower complication rates and decreased length of stay. In this study, obesity did not significantly impact rates of perforation, operative approach, length of stay, infectious complications, or readmission.

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Open cystectomy is still alive and well: Outcomes from a single-centre 6-year review

Journal of Clinical Urology ◽

10.1177/2051415818759366 ◽

2018 ◽

Vol 12 (3) ◽

pp. 239-245

Author(s):

Alexios Dosis ◽

Blessing Dhliwayo ◽

Patrick Jones ◽

Iva Kovacevic ◽

Jonathan Yee ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Length Of Hospital Stay ◽

Categorical Variables ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Single Centre ◽

Significant Difference ◽

Duration Of Surgery

Objectives: To compare perioperative and oncological outcomes between open and laparoscopic radical cystectomy in a single-centre setting. Materials and methods: This study was a retrospective cohort (level 2b evidence) non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS v21.0. Quantitative values were compared with Student’s t-test; categorical variables with the chi-square test. Statistical significance was considered a result of an alpha value less than 0.05. A Kaplan–Meier survival analysis was also conducted. Results: Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs. 716±570 mL, P=0.15), which had a significant impact on transfusion rates ( P=0.02). Operative times were lower in open surgery (339±52.9 vs. 353.1±67.1 minutes, P=0.10), while hospital stay was lower in the laparoscopic group (14.2±11.2 vs. 16.0±13.6 days, P=0.28). Five-year survival rates were superior for patients who underwent an open procedure but were not statistically significant ( P=0.10). Conclusion: This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. The laparoscopic approach can reduce the need for transfusion; however, there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss, survival and margin positivity. Level of evidence: Not applicable for this multicentre audit.

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A study of use of bipolar cautery in thyroidectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20170862 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1059

Author(s):

Vasuki R. ◽

Thanmaran N. B. ◽

Malathi V. ◽

Lizrose Kujur

Keyword(s):

Blood Loss ◽

Wound Infection ◽

Morbidity Rate ◽

Complication Rates ◽

Knot Tying ◽

Time Duration ◽

Female Ratio ◽

Bipolar Cautery ◽

Duration Of Surgery ◽

Knot Tying Technique

Background: Thyroidectomy is one of the most commonly performed surgeries throughout the world which has an extremely low morbidity rate. Nowadays with the advent of newer techniques the duration of surgery and complications have decreased. Conventionally Thyroidectomy was done by suture knot tying technique which needs large number of surgical ties and also time consuming. It decreases healing as well as increases wound infection, injury to neighboring structures and foreign body reaction.Methods: In this study, I selected 50 patients with thyroid swelling attending the surgery outpatient department from February 2015 to August 2015. Thyroid surgery was done using bipolar cautery. The results were analyzed.Results: This study shows most of the patients belong to 30-40 years followed by 40-50 years. The male: female ratio is 1:25. Time duration varies from 50 minutes to 135 minutes. The longer duration of surgery compared to other studies is attributed to learning curve. We started using bipolar diathermy since 2013. The blood loss ranges from 25-50 ml. Complication rates are also less with bipolar thyroidectomy, 2% had postoperative hemorrhage, 2% developed temporary RLN palsy, 2% developed minor degree of wound infection, and 6% developed signs and symptoms of hypocalcemia. The mean duration of hospital stay was 4 days.Conclusions: Thyroidectomy using bipolar cautery is safe and effective method and also less time consuming. The cost of the bipolar cautery is less compared to harmonic scalpel and LigaSure. Bipolar cautery is available in our government hospital. Blood loss using Bipolar Cautery is less compared to conventional Knot–tying technique. The post-operative complications are less with bipolar cautery.

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2016.7.spine16448 ◽

2017 ◽

Vol 26 (2) ◽

pp. 158-162 ◽

Cited By ~ 29

Author(s):

Ikemefuna Onyekwelu ◽

Steven D. Glassman ◽

Anthony L. Asher ◽

Christopher I. Shaffrey ◽

Praveen V. Mummaneni ◽

...

Keyword(s):

Back Pain ◽

Lumbar Spine ◽

Hospital Stay ◽

Clinical Outcomes ◽

Spine Surgery ◽

Lumbar Fusion ◽

Lumbar Spine Surgery ◽

Complication Rates ◽

Obese Patients ◽

Nonobese Patients

OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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Robotic Hysterectomy for Endometrial Cancer in Obese Patients With Comorbidities: Evaluating Postoperative Complications

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000480 ◽

2015 ◽

Vol 25 (7) ◽

pp. 1271-1276 ◽

Cited By ~ 13

Author(s):

Floor J. Backes ◽

Maggie Rosen ◽

Margaret Liang ◽

Georgia A. McCann ◽

Aine Clements ◽

...

Keyword(s):

Endometrial Cancer ◽

Postoperative Complications ◽

Postoperative Complication ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Additional Patient ◽

Complication Rates ◽

Obese Patients ◽

Robotic Hysterectomy ◽

Nonobese Patients

ObjectivesThe objective of this study is to determine (1) if there is a relationship between increasing body mass index (BMI) and postoperative complications in patients undergoing robotic hysterectomy for endometrial cancer and (2) if there are additional patient characteristics, specifically preoperative comorbidities, which increase the risk of postoperative complicationMethodsA retrospective chart review was conducted on women who underwent a robotic staging surgery for endometrial cancer from 2006 to 2012. Basic demographics and preoperative and postoperative complications were extracted from the medical records. Obesity was divided into 4 categories, and complication rates were compared across these subgroups. Patients were also divided by the number of comorbidities and compared.ResultsThe cohort included 543 patients. The BMI ranged from 17.3 to 69.5 kg/m2. Three hundred eighty patients (70%) were obese (BMI >30 kg.m2). One hundred ninety patients (35%) had no comorbidities other than obesity, and 180 patients (33%) had only 1 comorbidity other than obesity (Table 1).Postoperative complications occurred in 102 (18.7%) of the patients. Severe postoperative complications, including intensive care unit admission, reintubation, reoperation, and perioperative death, occurred in 14 patients (2.6%). Of the nonobese patients, 27 (16.5%) had postoperative complications; of the obese patients, 75 (19.7%) had a complication (P = 0.38). In patients with no comorbidities, 16.3% had a complication; 18% of patients with 1 to 2 comorbidities had a complication, and 28% of patients with 3 or more comorbidities had a complication (P = 0.08).ConclusionsThe postoperative complication rate based on BMI or number of comorbidities was not statistically significant, but patients with greater number of comorbidities had an increased rate of postoperative complications. Patients with certain comorbidities, cardiac and renal specifically, had the highest rates of postoperative complications.

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