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

2015 ◽  
Vol 25 (7) ◽  
pp. 1271-1276 ◽  
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.

scholarly journals Obesity Does Not Increase Mortality after Emergency Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
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.

Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery

2019 ◽  
Vol 33 (06) ◽  
pp. 525-530
Author(s):  
Jayson Lian ◽  
Neel K. Patel ◽  
Michael Nickoli ◽  
Ravi Vaswani ◽  
James J. Irrgang ◽  
...  
Keyword(s):  
Wound Infection ◽  
Lateral Meniscus ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Future Research ◽  
Complication Rates ◽  
Obese Patients ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
Nonobese Patients

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.

A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery

2015 ◽  
Vol 81 (8) ◽  
pp. 755-759 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John C. Kubasiak ◽  
Imke Janssen ◽  
Jonathan A. Myers ◽  
Minh B. Luu
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Postoperative Complication ◽  
General Surgery ◽  
Meld Score ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Umbilical Hernia Repair ◽  
The Mean

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients’ increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

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.

Postoperative Complications Following Repair of Acute Achilles Tendon Rupture

2019 ◽  
Vol 40 (6) ◽  
pp. 679-686 ◽  
Author(s):  
X. J. Ruben Stavenuiter ◽  
Bart Lubberts ◽  
Robert M. Prince ◽  
A. Holly Johnson ◽  
Christopher W. DiGiovanni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Achilles Tendon ◽  
Postoperative Complication ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Subspecialty Training ◽  
Complication Rates ◽  
Operative Repair ◽  
Trauma Surgeons

Background: Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of—and specific risk factors associated with—postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. Methods: Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. Results: Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. Conclusion: Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. Level of Evidence: Level III, retrospective comparative series.

Laparoscopic Versus Robotic Hysterectomy in Obese Patients With Early-stage Endometrial Cancer: A Single-centre Analysis

2021 ◽  
Vol 41 (8) ◽  
pp. 4163-4167
Author(s):  
KENTA YOSHIDA ◽  
EIJI KONDO ◽  
RYO NIMURA ◽  
SHINTARO MAKI ◽  
MICHIKO KANEDA ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Obese Patients ◽  
Robotic Hysterectomy ◽  
Single Centre ◽  
Early Stage Endometrial Cancer

Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis

2018 ◽  
Vol 44 (12) ◽  
pp. 1935-1941 ◽  
Author(s):  
Giacomo Corrado ◽  
Enrico Vizza ◽  
Vito Cela ◽  
Liliana Mereu ◽  
Stefano Bogliolo ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Institutional Analysis ◽  
Obese Patients ◽  
Robotic Hysterectomy

scholarly journals Complications of Spine Surgery in “Super Obese” Patients

2020 ◽  
pp. 219256822095339
Author(s):  
Gennadiy A. Katsevman ◽  
Scott D. Daffner ◽  
Nicholas J. Brandmeir ◽  
Sanford E. Emery ◽  
John C. France ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Complication Rate ◽  
Elective Surgery ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Control Group ◽  
Complication Rates ◽  
Obese Patients ◽  
Super Obese ◽  
Indications And Complications

Study Design: Retrospective chart review with matched control. Objective: To evaluate the indications and complications of spine surgery on super obese patients. Methods: A retrospective review assessed super obese patients undergoing spine surgery at a level-1 trauma and spine referral center from 2012 to 2016. Outcomes were compared to age-matched controls with body mass index (BMI) <50 kg/m2. The control group was further subdivided into patients with BMI <30 kg/m2 (normal) and BMI between 30 and 50 kg/m2 (obese). Results: Sixty-three super obese patients undergoing 86 surgeries were identified. Sixty patients (78 surgeries) were in the control group. Age and number of elective versus nonelective cases were not significantly different. Mean BMI of the super obese group was 55 kg/m2 (range 50-77 kg/m2) versus 29 kg/m2 in the controls (range 20-49 kg/m2). Fifty-two percent of surgeries were elective, and the most common indication was degenerative disease (39%). Compared with controls, super obese patients had a higher complication rate (30% [n = 19] vs 10% [N = 6], P = .0055) but similar 30-day mortality rate (5% vs 5%), a finding that was upheld when comparing super obese with each of the control group stratifications (BMI 30-50 and BMI <30 kg/m2). The most common complication among super obese patients was wound dehiscence/infection (n = 8, 13%); 2 patients’ surgeries were aborted. Complication rates for elective surgery were 21% (n = 7) for super obese patients and 4% (n = 1) for controls ( P = .121); complication rates for nonelective procedures were 40% (n = 12) and 14% (n = 5), respectively ( P = .023). Conclusion: The complication rate of spine surgery in super obese patients (BMI ≥ 50 kg/m2) is significantly higher than other patients, particularly for nonelective cases.

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