Influence of Obesity on Surgical Regional Anesthesia in the Ambulatory Setting: An Analysis of 9,038 Blocks

2005 ◽  
Vol 102 (1) ◽  
pp. 181-187 ◽  
Author(s):  
Karen C. Nielsen ◽  
Ulrich Guller ◽  
Susan M. Steele ◽  
Stephen M. Klein ◽  
Roy A. Greengrass ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Regional Anesthesia ◽  
The United States ◽  
Ambulatory Setting ◽  
Efficacy Rate ◽  
Complication Rates ◽  
Obese Patients ◽  
Acute Complications ◽  
Pain At Rest ◽  
The Impact

Background Regional anesthesia is increasing in popularity for ambulatory surgical procedures. Concomitantly, the prevalence of obesity in the United States population is increasing. The objective of the present investigation was to assess the impact of body mass index (BMI) on patient outcomes after ambulatory regional anesthesia. Methods This study was based on prospectively collected data including 9,038 blocks performed on 6,920 patients in a single ambulatory surgery center. Patients were categorized into three groups according to their BMI (<25 kg/m2, 25-29 kg/m2, > or =30 kg/m2). Block efficacy, rate of acute complications, postoperative pain (at rest and with movement), postoperative nausea and vomiting, rate of unscheduled hospital admissions, and overall patient satisfaction were assessed. Linear and logistic multivariable analyses were used to obtain the risk-adjusted effect of BMI on these outcomes. Results Of all patients 34.8% had a BMI <25 kg/m2, 34.0% were overweight (BMI 25-29 kg/m2), and 31.3% were obese (BMI > or = 30 kg/m2). Patients with BMI > or =30 kg/m2 were 1.62 times more likely to have a failed block (P = 0.04). The unadjusted rate of acute complications was higher in obese patients (P = 0.001). However, when compared with patients with a normal BMI, postoperative pain at rest, unanticipated admissions, and overall satisfaction were similar in overweight and obese patients. Conclusions The present investigation shows that obesity is associated with higher block failure and complication rates in surgical regional anesthesia in the ambulatory setting. Nonetheless, the rate of successful blocks and overall satisfaction remained high in patients with increased BMI. Therefore, overweight and obese patients should not be excluded from regional anesthesia procedures in the ambulatory setting.

scholarly journals Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study

2019 ◽  
Vol 13 ◽  
pp. 175346661984123 ◽  
Author(s):  
Mark R. Bowling ◽  
Erik E. Folch ◽  
Sandeep J. Khandhar ◽  
Jordan Kazakov ◽  
William S. Krimsky ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Subgroup Analysis ◽  
The United States ◽  
Lung Lesion ◽  
Endobronchial Ultrasound ◽  
Complication Rates ◽  
Electromagnetic Navigation ◽  
Cancer Management ◽  
The Impact

Background: Fiducial markers (FMs) help direct stereotactic body radiation therapy (SBRT) and localization for surgical resection in lung cancer management. We report the safety, accuracy, and practice patterns of FM placement utilizing electromagnetic navigation bronchoscopy (ENB). Methods: NAVIGATE is a global, prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. This prospectively collected subgroup analysis presents the patient demographics, procedural characteristics, and 1-month outcomes in patients undergoing ENB-guided FM placement. Follow up through 24 months is ongoing. Results: Two-hundred fifty-eight patients from 21 centers in the United States were included. General anesthesia was used in 68.2%. Lesion location was confirmed by radial endobronchial ultrasound in 34.5% of procedures. The median ENB procedure time was 31.0 min. Concurrent lung lesion biopsy was conducted in 82.6% (213/258) of patients. A mean of 2.2 ± 1.7 FMs (median 1.0 FMs) were placed per patient and 99.2% were accurately positioned based on subjective operator assessment. Follow-up imaging showed that 94.1% (239/254) of markers remained in place. The procedure-related pneumothorax rate was 5.4% (14/258) overall and 3.1% (8/258) grade ⩾ 2 based on the Common Terminology Criteria for Adverse Events scale. The procedure-related grade ⩾ 4 respiratory failure rate was 1.6% (4/258). There were no bronchopulmonary hemorrhages. Conclusion: ENB is an accurate and versatile tool to place FMs for SBRT and localization for surgical resection with low complication rates. The ability to perform a biopsy safely in the same procedure can also increase efficiency. The impact of practice pattern variations on therapeutic effectiveness requires further study. Trial registration: ClinicalTrials.gov identifier: NCT02410837.

Obesity Does Not Impact Outcomes for Appendicitis

2012 ◽  
Vol 78 (2) ◽  
pp. 254-257 ◽  
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.

scholarly journals National Trends in Out-of-Pocket 1 Costs Among U.S. Adults With Diabetes Aged 18–64 Years: 2001–2017

2021 ◽  
Author(s):  
Yu Wang ◽  
Joohyun Park ◽  
Rui Li ◽  
Elizabeth Luman ◽  
Ping Zhang
Keyword(s):  
Medical Expenditure Panel Survey ◽  
Drug Prescription ◽  
Private Insurance ◽  
The United States ◽  
Medical Expenditure ◽  
Complication Rates ◽  
Poverty Level ◽  
Cost Rate ◽  
National Trends ◽  
The Impact

<b>Objective</b> <p>To assess national trends in out-of-pocket (OOP) costs among adults aged 18–64 years with diabetes in the United States. </p> <p><b>Research design and methods</b></p> <p>Using data from the 2001–2017 Medical Expenditure Panel Survey, we estimated total per person annual OOP costs (insurance premiums, prescription drug costs, inpatient and outpatient deductibles, and copays, and other payments not covered by insurance) and high OOP cost rate defined as the percentage of people with OOP spending more than 10% of their family’s pretax income. We examined trends overall, by subgroup (insurance type, income level, insulin use, size of patient’s employer, and whether the patient was enrolled in a high deductible health plan), and by type of service. Changes in trends were identified using joinpoint analysis; costs were adjusted to 2017 US dollars.</p> <p><b>Results</b></p> <p>From 2001 to 2017, OOP costs decreased 4.3%, from $4,328 to $4,139, and high OOP cost rate fell 32%, from 28% to 19% (<i>P</i> < 0.001). Changes in the high OOP cost rate varied by subgroup, declining among those with public or no insurance and those with an income <200% of the federal poverty level (<i>P</i> < 0.001), but remaining stable among those with private insurance and higher income. Drug prescription OOP costs decreased among all subgroups (<i>P</i> < 0.001). Decreases in total (-$58 vs -$37, <i>P</i> < 0.001) and prescription (-$79 vs -$68, <i>P</i> < 0.001) OOP costs were higher among insulin users than noninsulin users. </p> <p><b>Conclusions</b></p> OOP costs among US nonelderly adults with diabetes declined, especially among those least able to afford them. Future studies may explore factors contributing to the decline in OOP costs and the impact on the quality of diabetes care and complication rates.

scholarly journals National Trends in Out-of-Pocket 1 Costs Among U.S. Adults With Diabetes Aged 18–64 Years: 2001–2017

2021 ◽  
Author(s):  
Yu Wang ◽  
Joohyun Park ◽  
Rui Li ◽  
Elizabeth Luman ◽  
Ping Zhang
Keyword(s):  
Medical Expenditure Panel Survey ◽  
Drug Prescription ◽  
Private Insurance ◽  
The United States ◽  
Medical Expenditure ◽  
Complication Rates ◽  
Poverty Level ◽  
Cost Rate ◽  
National Trends ◽  
The Impact

<b>Objective</b> <p>To assess national trends in out-of-pocket (OOP) costs among adults aged 18–64 years with diabetes in the United States. </p> <p><b>Research design and methods</b></p> <p>Using data from the 2001–2017 Medical Expenditure Panel Survey, we estimated total per person annual OOP costs (insurance premiums, prescription drug costs, inpatient and outpatient deductibles, and copays, and other payments not covered by insurance) and high OOP cost rate defined as the percentage of people with OOP spending more than 10% of their family’s pretax income. We examined trends overall, by subgroup (insurance type, income level, insulin use, size of patient’s employer, and whether the patient was enrolled in a high deductible health plan), and by type of service. Changes in trends were identified using joinpoint analysis; costs were adjusted to 2017 US dollars.</p> <p><b>Results</b></p> <p>From 2001 to 2017, OOP costs decreased 4.3%, from $4,328 to $4,139, and high OOP cost rate fell 32%, from 28% to 19% (<i>P</i> < 0.001). Changes in the high OOP cost rate varied by subgroup, declining among those with public or no insurance and those with an income <200% of the federal poverty level (<i>P</i> < 0.001), but remaining stable among those with private insurance and higher income. Drug prescription OOP costs decreased among all subgroups (<i>P</i> < 0.001). Decreases in total (-$58 vs -$37, <i>P</i> < 0.001) and prescription (-$79 vs -$68, <i>P</i> < 0.001) OOP costs were higher among insulin users than noninsulin users. </p> <p><b>Conclusions</b></p> OOP costs among US nonelderly adults with diabetes declined, especially among those least able to afford them. Future studies may explore factors contributing to the decline in OOP costs and the impact on the quality of diabetes care and complication rates.

The Impact of BMI on Adult Blunt Trauma Outcomes

2019 ◽  
Vol 85 (12) ◽  
pp. 1354-1362
Author(s):  
Rahman Barry ◽  
Milad Modarresi ◽  
Rodrigo Aguilar ◽  
Jacqueline Sanabria ◽  
Thao Wolbert ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Obese Patients ◽  
The Impact

Traumatic injuries account for 10% of all mortalities in the United States. Globally, it is estimated that by the year 2030, 2.2 billion people will be overweight (BMI ≥ 25) and 1.1 billion people will be obese (BMI ≥ 30). Obesity is a known risk factor for suboptimal outcomes in trauma; however, the extent of this impact after blunt trauma remains to be determined. The incidence, prevalence, and mortality rates from blunt trauma by age, gender, cause, BMI, year, and geography were abstracted using datasets from 1) the Global Burden of Disease group 2) the United States Nationwide Inpatient Sample databank 3) two regional Level II trauma centers. Statistical analyses, correlations, and comparisons were made on a global, national, and state level using these databases to determine the impact of BMI on blunt trauma. The incidence of blunt trauma secondary to falls increased at global, national, and state levels during our study period from 1990 to 2015, with a corresponding increase in BMI at all levels ( P < 0.05). Mortality due to fall injuries was higher in obese patients at all levels ( P < 0.05). Analysis from Nationwide Inpatient Sample database demonstrated higher mortality rates for obese patients nationally, both after motor vehicle collisions and mechanical falls ( P < 0.05). In obese and nonobese patients, regional data demonstrated a higher blunt trauma mortality rate of 2.4% versus 1.2%, respectively ( P < 0.05) and a longer hospital length of stay of 4.13 versus 3.26 days, respectively ( P = 0.018). The obesity rate and incidence of blunt trauma secondary to falls are increasing, with a higher mortality rate and longer length of stay in obese blunt trauma patients.

scholarly journals Impact of caregiver overnight stay on postoperative outcomes

2019 ◽  
Vol 33 (1) ◽  
pp. 18-26
Author(s):  
Susan Griffin ◽  
Leigh McGrath ◽  
Gregory T. Chesnut ◽  
Nicole Benfante ◽  
Melissa Assel ◽  
...  
Keyword(s):  
Ambulatory Surgery ◽  
Surgical Techniques ◽  
Postoperative Outcomes ◽  
Urgent Care ◽  
Ambulatory Setting ◽  
Complication Rates ◽  
Content Type ◽  
Overnight Stay ◽  
Number Of Patients ◽  
The Impact

Purpose The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. Design/methodology/approach This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. Findings Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. Originality/value This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.

scholarly journals Reduced Risk of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From a United States Claims Database

2021 ◽  
Vol 12 ◽  
Author(s):  
Chengyuan Wu ◽  
Sean J. Nagel ◽  
Rahul Agarwal ◽  
Monika Pötter-Nerger ◽  
Wolfgang Hamel ◽  
...  
Keyword(s):  
United States ◽  
Risk Reduction ◽  
De Novo ◽  
The United States ◽  
Secondary Outcome ◽  
Administrative Claims ◽  
Complication Rates ◽  
Claims Database ◽  
The Impact ◽  
Deep Brain

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.Design: Retrospective, contemporaneous cohort study.Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, of which 3,869 patients had a de novo implant and primary diagnosis of PD or ET. Follow-up of 3 months was available for 3,810 patients, 12 months for 3,561 patients, and 24 months for 1,812 patients.Intervention: Implantation of a modern directional (MD) or traditional omnidirectional (TO) DBS system.Primary and Secondary Outcome Measures: We hypothesized that MD systems would impact complication rates. Reoperation rate was the primary outcome. Associated diagnoses, patient characteristics, and implanting center details served as covariates. Kaplan–Meier analysis was performed to compare rates of event-free survival and regression models were used to determine covariate influences.Results: Patients implanted with modern systems were 36% less likely to require reoperation, largely due to differences in acute reoperations and intracranial lead reoperations. Risk reduction persisted while accounting for practice differences and implanting center experience. Risk reduction was more pronounced in patients with PD.Conclusions: In the first multicenter analysis of device-related complications including modern DBS systems, we found that modern systems are associated with lower reoperation rates. This risk profile should be carefully considered during device selection for patients undergoing DBS for PD or ET. Prospective studies are needed to further investigate underlying causes.

Abstract 16538: The Impact of Institutional Design on Transcatheter Aortic Valve Replacement Complication Rates in the United States

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sadip Pant ◽  
Samir Patel ◽  
Harsh Golwala ◽  
Nilesh Patel ◽  
Apurva Badheka ◽  
...  
Keyword(s):  
United States ◽  
Heart Surgery ◽  
Institutional Design ◽  
Open Heart Surgery ◽  
Hospital Setting ◽  
The United States ◽  
Hospital Inpatient ◽  
Complication Rates ◽  
Hospital Size ◽  
The Impact

Introduction: With the technical advancements and expanding indications, utilization of TAVR is on the rise among various institutions in the United States .While appropriate patient selection and better techniques are essential to improving outcomes, the impact of institutional design (or hospital setting) on outcomes with TAVR has yet to be examined. Objective: The objective of our study is to compare TAVR complication rates among teaching vs non-teaching centers in the United States Methods: We used Healthcare Cost and Utilization Project - National Inpatient Sample (NIS) data , the largest all payer database of hospital inpatient stay available in United States, to identify patients (age ≥18 years) who underwent TAVR from Jan-Dec 2012. We constructed multivariable models to determine independent predictors (age, sex, race, Charlson’s comorbidity index, hospital size, hospital location and TAVR approach) of TAVR-associated complications. Statistical analysis was performed using Stata IC 11.0 (Stata-Corp, College Station, TX). Results: We identified 7,405 TAVR procedures performed in the United States in 2012. 88% of TAVR were performed in teaching centers. There was no difference in mortality following TAVR between teaching and non-teaching centers. The occurrence of any in-hospital complication was lower in teaching centers as compared to non-teaching centers (42% vs. 50%, p<0.001). Rates of individual complications in teaching vs. non-teaching centers are illustrated in the figure. In adjusted analysis, hemorrhage requiring transfusion (13.2% vs. 20.8%, p<0.001), renal complications requiring dialysis (1.2% vs. 2.3%, p=0.009), respiratory complications (7.5% vs. 11%, p<0.001) and complications requiring open-heart surgery (2% vs. 4.6%, p<0.001) were lower in teaching centers as compared to non-teaching centers. Vascular access site complications, pacemaker insertion, pericardial and neurological complications were similar between teaching and non-teaching centers (Figure). Conclusion: Institutional design impacts TAVR complication rates albeit no difference in mortality. In general, complication rates are lower in teaching centers compared to non-teaching centers.

scholarly journals Elective hip arthroplasty rates and related complications in people with diabetes mellitus

2020 ◽  
pp. 112070002098157
Author(s):  
Lindsey C McVey ◽  
Nicholas Kane ◽  
Helen Murray ◽  
RM Dominic Meek ◽  
S Faisal Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Complications ◽  
Glycaemic Control ◽  
Hip Arthroplasty ◽  
Surgical Complications ◽  
Complication Rates ◽  
Obese Patients ◽  
Poor Glycaemic Control ◽  
Increased Risk ◽  
The Impact

Background and Aims: Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. Methods: We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). Results: Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls ( p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls ( p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls ( p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control ( p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients ( p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI ( p = 0.587). Conclusions: DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.

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