The Influence of Body Mass Index in Obese and Morbidly Obese Patients on Complications and 30- and 90-day Readmissions Following Lumbar Spine Fusion

The purpose of our study is to determine whether body mass index (BMI = weight in kg/height in meters2) was related to the rate of negative appendectomy in patients who underwent preoperative CT. A surgical database search performed using the procedure code for appendectomy identified 925 patients at least 18 years of age who underwent urgent appendectomy between January 1998 and September 2007. BMI was computed for the 703 of these 925 patients for whom height and weight information was available. Patients were stratified based on body mass index (BMI 15-18.49 = underweight; 18.5-24.9 = normal weight; 25–29.9 = overweight; 30-39.9 = obese; > 40 = morbidly obese). Negative appendectomy rates were computed. Negative appendectomy rates for patients who did and did not undergo preoperative CT were 27 per cent and 50 per cent for underweight patients, 10 per cent and 15 per cent for normal weight patients, 12 per cent and 17 per cent for overweight patients, 7 per cent and 30 per cent for obese patients, and 10 per cent and 100 per cent for morbidly obese patients. The difference in negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT as compared with patients in the same BMI category who did not undergo preoperative CT was statistically significant ( P ≤ 0.001). The negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT were significantly lower than for patients in these same BMI categories who did not undergo preoperative CT.

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Positive End-expiratory Pressure Improves Respiratory Function in Obese but not in Normal Subjects during Anesthesia and Paralysis

Anesthesiology ◽

10.1097/00000542-199911000-00011 ◽

1999 ◽

Vol 91 (5) ◽

pp. 1221-1221 ◽

Cited By ~ 256

Author(s):

Paolo Pelosi ◽

Irene Ravagnan ◽

Gabriella Giurati ◽

Mauro Panigada ◽

Nicola Bottino ◽

...

Keyword(s):

Body Mass Index ◽

Chest Wall ◽

Body Mass ◽

Respiratory System ◽

Respiratory Function ◽

Normal Subjects ◽

Intraabdominal Pressure ◽

Morbidly Obese ◽

Obese Patients ◽

Positive End Expiratory Pressure

Background Morbidly obese patients, during anesthesia and paralysis, experience more severe impairment of respiratory mechanics and gas exchange than normal subjects. The authors hypothesized that positive end-expiratory pressure (PEEP) induces different responses in normal subjects (n = 9; body mass index < 25 kg/m2) versus obese patients (n = 9; body mass index > 40 kg/m2). Methods The authors measured lung volumes (helium technique), the elastances of the respiratory system, lung, and chest wall, the pressure-volume curves (occlusion technique and esophageal balloon), and the intraabdominal pressure (intrabladder catheter) at PEEP 0 and 10 cm H2O in paralyzed, anesthetized postoperative patients in the intensive care unit or operating room after abdominal surgery. Results At PEEP 0 cm H2O, obese patients had lower lung volume (0.59 +/- 0.17 vs. 2.15 +/- 0.58 l [mean +/- SD], P < 0.01); higher elastances of the respiratory system (26.8 +/- 4.2 vs. 16.4 +/- 3.6 cm H2O/l, P < 0.01), lung (17.4 +/- 4.5 vs. 10.3 +/- 3.2 cm H2O/l, P < 0.01), and chest wall (9.4 +/- 3.0 vs. 6.1 +/- 1.4 cm H2O/l, P < 0.01); and higher intraabdominal pressure (18.8 +/-7.8 vs. 9.0 +/- 2.4 cm H2O, P < 0.01) than normal subjects. The arterial oxygen tension was significantly lower (110 +/- 30 vs. 218 +/- 47 mmHg, P < 0.01; inspired oxygen fraction = 50%), and the arterial carbon dioxide tension significantly higher (37.8 +/- 6.8 vs. 28.4 +/- 3.1, P < 0.01) in obese patients compared with normal subjects. Increasing PEEP to 10 cm H2O significantly reduced elastances of the respiratory system, lung, and chest wall in obese patients but not in normal subjects. The pressure-volume curves were shifted upward and to the left in obese patients but were unchanged in normal subjects. The oxygenation increased with PEEP in obese patients (from 110 +/-30 to 130 +/- 28 mmHg, P < 0.01) but was unchanged in normal subjects. The oxygenation changes were significantly correlated with alveolar recruitment (r = 0.81, P < 0.01). Conclusions During anesthesia and paralysis, PEEP improves respiratory function in morbidly obese patients but not in normal subjects.

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Study on Psychiatric Evaluation of Morbidly Obese Patients

International Neuropsychiatric Disease Journal ◽

10.9734/indj/2021/v16i230169 ◽

2021 ◽

pp. 8-16

Author(s):

Asmaa Reda Elsayed Elshazly ◽

Mohammad Abdelhakeem Seleem ◽

Mohamed Hamdy Abo-Ryia ◽

Adel Abdel-Kareem Badawy

Keyword(s):

Mental Health ◽

Body Mass Index ◽

Morbid Obesity ◽

Binge Eating ◽

Psychiatric Disorders ◽

Body Mass ◽

Eating Attitude ◽

Control Group ◽

Morbidly Obese ◽

Obese Patients

Background: Obesity is becoming an important issue for health promotion. The World Health Organization estimated that around 1.5 billion adults were overweight (body mass index (BMI) 25 kg/m2) and about 500 million people were obese (BMI 30 kg/m2) in 2008. The relationship between obesity and mental health is also considered important. In a community-based study, obesity was positively associated with several mental disorders, especially mood disorders and anxiety disorders. The aim of the study is the assessment of current and lifetime psychiatric disorders among morbidly obese patients. Methods: This case control study was conducted on 60 participants from outpatient clinic of GIT surgery unit and community. All participants were subjected to: Body weight and body mass index, Psychiatric interview for diagnosis of psychiatric disorders by Arabic version of MINI, Scale for diagnosis of Bulimia nervosa by Shokeer, Scale for diagnosis of Anorexia Nervosa by Shokeer, Binge Eating Disorder Screener-7, Eating attitude test, Hamilton Depressions Rating Scale and Hamilton anxiety scale. Results: There was a significant increase in anxiety in patients with morbid obesity compared to control group. There was a significant difference between both groups showing the high prevalence of depression in patients with morbid obesity. Based on EAT test, there was a significant prevalence of abnormal eating behaviors in patients group compared to none of control group. A screening test for the presence of Binge eating symptoms revealed significant increase of symptoms in patients’ group. Conclusions: Psychiatric disorders are prevalent in morbidly obese patients and are associated with significantly worse quality of life. In addition, morbidly obese patients had significantly worse physical and mental health relative to control group from general population. High rates of psychiatric disorders among morbidly obese patients seem to be the rule rather than an exception.

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Prevalence and Predictors of Nonalcoholic Steatohepatitis in Obese Patients Undergoing Bariatric Surgery: A Department of Defense Experience

The American Surgeon ◽

10.1177/000313481408000624 ◽

2014 ◽

Vol 80 (6) ◽

pp. 595-599 ◽

Cited By ~ 15

Author(s):

Jeffrey L. Reha ◽

Sukhyung Lee ◽

Luke J. Hofmann

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Nonalcoholic Steatohepatitis ◽

Normal Liver ◽

Multivariate Regression Analysis ◽

Common Finding ◽

Systemic Hypertension ◽

Morbidly Obese ◽

Obese Patients ◽

Increased Risk

Nonalcoholic steatohepatitis (NASH) is a silent liver disease that can lead to inflammation and subsequent scaring. If left untreated, cirrhosis may ensue. Morbidly obese patients are at an increased risk of NASH. We report the prevalence and predictors of NASH in patients undergoing morbid obesity surgery. A retrospective review was conducted on morbidly obese patients undergoing weight reduction surgery from September 2005 through December 2008. A liver biopsy was performed at the time of surgery. Patients who had a history of hepatitis infection or previous alcohol dependency were excluded. Prevalence of NASH was studied. Predictors of NASH among clinical and biochemical variables were analyzed using multivariate regression analysis. One hundred thirteen patients were analyzed (84% female; mean age, 42.6 ± 11.4 years; mean body mass index, 45.1 ± 5.7 kg/m2). Sixty-one patients had systemic hypertension (54%) and 35 patients had diabetes (31%). The prevalence of NASH in this study population was 35 per cent (40 of 113). An additional 59 patients (52%) had simple steatosis without NASH. Only 14 patients had normal liver histology. On multivariate analysis, only elevated aspartate aminotransferase (AST) (greater than 41 IU/L) was the independent predictor for NASH (odds ratio, 5.85; confidence interval, 1.06 to 32.41). Patient age, body mass index, hypertension, diabetes, hypercholesterolemia, and abnormal alanine aminotransferase did not predict NASH. NASH is a common finding in obese population. Abnormal AST was the only predictive factor for NASH.

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Morbid Obesity Impacts Mortality in Blunt Trauma

The American Surgeon ◽

10.1177/000313480707301108 ◽

2007 ◽

Vol 73 (11) ◽

pp. 1122-1125 ◽

Cited By ~ 7

Author(s):

A. Britton Christmas ◽

Jennifer Reynolds ◽

Ashley K. Wilson ◽

Glen A. Franklin ◽

Frank B. Miller ◽

...

Keyword(s):

Body Mass Index ◽

Morbid Obesity ◽

Injury Severity Score ◽

Blunt Trauma ◽

Body Mass ◽

Severity Score ◽

Injury Severity ◽

Morbidly Obese ◽

Normal Body Mass Index ◽

Obese Patients

Twenty-six per cent of adults in the Unites States are obese and trauma remains a major cause of death. We assessed the impact of morbid obesity on mortality in patients with blunt trauma. We reviewed the records of patients with a body mass index 40 kg/m2 or greater injured by blunt trauma from 1993 to 2003 and compared them with a 4:1 control population with a normal body mass index and matched for sex and constellation of injuries. For comparison, patients were categorized by Injury Severity Score 9 or less or Injury Severity Score 10 or greater. Student t test and χ2 were used for statistical analysis. P < 0.05 was considered significant. One hundred seven morbidly obese patients were identified and compared with 458 control subjects with a normal body mass index and matched for sex and constellation of injuries. Although the morbidly obese patients were found to be significantly younger, those who incurred multiorgan injury experienced a significantly longer hospital length of stay and displayed a greater than fourfold increase in mortality when compared with the control subjects. Furthermore, the number of morbidly obese patients admitted over the 10-year period significantly increased by fourfold (0.4% to 1.5%). Over the last decade, there has been a significant increase in morbidly obese patients cared for in our trauma center. Although these patients were significantly younger with a similar Glasgow Coma Score as that of the control population, morbid obesity significantly increased mortality when the injury from blunt trauma transitioned from a single to a multiorgan injury.

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