Does Pediatric Body Mass Index Affect Surgical Outcomes of Lower-Extremity External Fixation?

Background: Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated. Objectives: To compare body mass index adjusted using Amputee Coalition equations (body mass index–Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees. Study design: Cross-sectional, experimental. Methods: Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index–Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry. Results: Body mass index–Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index–Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index–Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = −0.59 and r = −0.66, p < 0.05) to the individual’s level of body fatness. Conclusions: Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index–Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a “correction” formula for limb loss.

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Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01558-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yanxiang Liu ◽

Bowen Zhang ◽

Shenghua Liang ◽

Yaojun Dun ◽

Luchen Wang ◽

...

Keyword(s):

Body Mass Index ◽

Adverse Events ◽

Aortic Dissection ◽

Body Mass ◽

Surgical Outcomes ◽

Type A ◽

Term Survival ◽

Type A Aortic Dissection ◽

Prolonged Ventilation ◽

The Impact

Abstract Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.

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