Ist die Adipositas ein Risikofaktor für postoperative Komplikationen nach Lungenlappenresektion?

2019 ◽  
Vol 7 (4) ◽  
pp. 200-201
Author(s):  
Thomas Lesser
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Lung Resection ◽  
Postoperative Mortality ◽  
Obesity Paradox ◽  
P Value ◽  
Obese Patients ◽  
Short Term ◽  
Lung Lobectomy ◽  
The Impact

Background: The aim of the present study was to evaluate the impact of BMI on the short-term outcomes of patients undergoing lung lobectomy. Methods: This was a retrospective clinical cohort study conducted in a single institution to assess the short-term outcomes of obese patients undergoing lung resection. Intraoperative and postoperative parameters were compared between the two study subgroups: obese (BMI ≥30 kg/m2) and non-obese patients (BMI <30 kg/m2). Results: In total, 203 patients were enrolled in the study (70 obese and 133 non-obese patients). Both study subgroups were comparable with regards to demographics, clinical data and surgical approach (thoracoscopy vs. thoracotomy). The surgery time was significantly longer in obese patients (p = 0.048). There was no difference in the frequency of intraoperative complications between the study subgroups (p = 0.635). The postoperative hospital stay was similar in both study subgroups (p = 0.366). A 30-day postoperative morbidity was higher in a subgroup of non-obese patients (33.8% vs. 21.7%), but the difference was not significant (p = 0.249). In the subgroup of non-obese patients, a higher frequency of mild and severe postoperative complications was observed. However, the differences between the study subgroups were not statistically significant due to the borderline p-value (p = 0.053). The 30-day postoperative mortality was comparable between obese and non-obese patients (p = 0.167). Conclusions: Obesity does not increase the incidence and severity of intraoperative and postoperative complications after lung lobectomy. Slightly better outcomes in obese patients indicate that obesity paradox might be a reality in patients undergoing lung resection.

scholarly journals Peculiarities of the postoperative period and postoperative consequences of left hemicolectomy in patients with obesity

2021 ◽  
Vol 25 (1) ◽  
pp. 45-49
Author(s):  
A. I. Sukhodolia ◽  
V. V. Kernychnyi ◽  
V. V. Balytskyi ◽  
S. A. Sukhodolia ◽  
B. E. Li
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Postoperative Mortality ◽  
Charlson Index ◽  
Obese Patients ◽  
Microsoft Excel ◽  
Mean Values ◽  
Left Hemicolectomy ◽  
Multi Stage ◽  
The Impact

Annotation. Obesity is considered a risk factor for postoperative complications and postoperative mortality. The aim of the study was to assess the impact of obesity on the postoperative period and the level of postoperative mortality after left hemicolectomy. A retrospective analysis of the medical records of 217 patients who underwent left hemicolectomy for colon tumors was performed. Assessment of comorbid conditions was performed using the Charlson index. Postoperative complications were assessed according to the Clavien-Dindo classification. The calculation of postoperative survival was performed by the Kaplan-Mayer method. Database formation and statistical analysis were performed using Microsoft Excel and STATISTICA 10.0. It was determined that the mean values of the Charlson index did not differ significantly between the two groups (6,31 ± 2,07 and 6,33 ± 2,08 respectively), but there was a significantly higher level of endocrine diseases in the group of obese patients. Non-disseminated (I-II) stages of the tumor process predominated in patients of both groups (60% and 57.5%, respectively). Among non-obese patients n = 107 (51.8%) patients had an uncomplicated postoperative period and n = 59 (28.5%) patients had mild complications that were not associated with the surgical site, but were associated with concomitant chronic pathology of other organs and systems, and did not require any invasive interventions. In contrast, among obese patients n = 6 (60%) patients had severe early postoperative complications requiring surgery, and n = 2 (20%) patients underwent relaparotomy. The rate of early postoperative mortality differed significantly between the two groups and was significantly higher among obese patients (40% vs 6.8% among non-obese patients). This study showed a significantly higher percentage of postoperative mortality and severity of postoperative complications in the group of obese patients. The prospect of further research is to study and analyze the course of the postoperative period in obese patients undergoing extended, multi-visceral and multi-stage surgery for cancer of the left half of the colon.

Abstract 18519: Withdrawal of Antiplatelet Therapy Results in Worse Short-term Prognosis in Patients Undergoing Elective Major Noncardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jesús álvarez-García ◽  
Miquel Vives-Borrás ◽  
Joan I Llao ◽  
Andreu Ferrero-Gregori ◽  
Marc Bausili ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Postoperative Mortality ◽  
Primary Outcome Measure ◽  
Noncardiac Surgery ◽  
Concomitant Treatment ◽  
Short Term ◽  
The Impact

Background: The decision whether to discontinue antiplatelet therapy in patients undergoing major noncardiac surgery can be clinically challenging. There is insufficient clinical evidence to establish comprehensive guidelines and most of recommendations are based on expert consensus. Objective: To evaluate the effectof withdrawal of antiplatelet therapy on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery. Age, gender, risk factors, previous chronic heart or lung disease, renal function, anemia and concomitant treatment were used in a binary logistic regression to determine the impact of withdrawal of antiplatelet therapy on prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: Five percent of patients presented the composite primary outcome measure of 30-day postoperative mortality or cardiovascular events. Antiplatelet therapy was withdrawn in 11.4% of patients (table). Discontinuation of antiplatelet therapy was associated with a significant increase in the primary outcome measure (OR 2.27; CI95%: 1.16-4.46). Conclusions: In a contemporary cohort of patients undergoing noncardiac surgery, withdrawal of antiplatelet therapy was associated with a worse short-term prognosis. There is an urgent need for further research in this field.

scholarly journals The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Ko-Chao Lee ◽  
Kuan-Chih Chung ◽  
Hong-Hwa Chen ◽  
Kung-Chuan Cheng ◽  
Kuen-Lin Wu ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Postoperative Complications ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Surgical Outcomes ◽  
Stage I ◽  
Open Colectomy ◽  
Short Term ◽  
Patients With Diabetes ◽  
The Impact

Purpose. This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods. The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results. A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion. The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.

scholarly journals Short-term rate of milk synthesis and expression interval of preterm mothers

2019 ◽  
Vol 105 (3) ◽  
pp. 266-269 ◽  
Author(s):  
Ching Tat Lai ◽  
Alethea Rea ◽  
Leon R Mitoulas ◽  
Jacqueline C Kent ◽  
Karen Simmer ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Milk Production ◽  
P Value ◽  
Inverse Association ◽  
Short Term ◽  
Start Time ◽  
Daily Milk Production ◽  
The Impact ◽  
Maximum Interval ◽  
Daily Milk

AimTo determine the impact of the pumping regimes of women with preterm infants on the daily milk production, and on the short-term rate of milk synthesis during early lactation to support evidence-based recommendations for optimising milk production.MethodsMothers of preterm infants (n=25) recorded start time, finish time and expression volumes from every breast expression on days 10, 15–20 postpartum.ResultsExpressing more often than five times per day did not result in a significant increase in daily milk production. Milk volume per expression per breast increased for intervals between expressions of between 2and6 hours then reached a plateau when the interval between expression was 7 hours or longer. The short-term rate of milk synthesis decreased as the interval between expressions increased until about 7.5 hours at which point it begun to increase (p value associated with interval between expressions^2<0.001).ConclusionThe strong inverse association between the short-term rate of milk synthesis and the interval between expressions for intervals up to 7 hours suggest that the maximum interval between expressions should be 7 hours. Data suggest that, on average, the mothers should express at least five times a day to maximise daily milk production. Considering inter-individual variation, determination of an individual mother’s maximum interval between expressions that does not compromise the short-term rate of milk synthesis will help to optimise daily milk production while minimising the demands on the mother’s time.

The Impact of Obesity on the Perioperative, Clinicopathologic, and Oncologic Outcomes of Robot Assisted Total Mesorectal Excision for Rectal Cancer

2017 ◽  
Vol 89 (4) ◽  
pp. 23-28 ◽  
Author(s):  
Ajit Pai ◽  
Fahad Alsabhan ◽  
John J. Park ◽  
George Melich ◽  
Suela Sulo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Length Of Stay ◽  
Operative Time ◽  
Statistical Significance ◽  
Oncologic Outcomes ◽  
P Value ◽  
Obese Patients ◽  
Lymph Node Yield ◽  
Conversion Rates ◽  
The Impact

Purpose: To analyze the feasibility and outcomes of robotic rectal cancer surgery in obese patients. Methods: From 2005 to 2012, 101 consecutive rectal cancers operated robotically were enrolled in a prospective database. Patients were stratified into obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) groups. Operative, perioperative parameters, and pathologic outcomes were compared. Data were analyzed using SPSS 22.0, while statistical significance was defined as a p value ≤ .05. Results: There were 33 obese patients (mean BMI 33.8 kg/m2). Patients were comparable regarding gender, T stage, and type of operation. Operative time and blood loss were higher in the obese group; only operative time was statistically significant. The conversion rate, length of stay, and anastomotic leak rates were similar. Circumferential margin positivity and lymph node yield were comparable. Disease free and overall survivals at 3 years were 75.8% versus 80.9% and 84.8% versus 92.6%, respectively for obese and non-obese subgroups. Conclusions: Robotic surgery for curative treatment of rectal cancer in the obese is safe and feasible. BMI does not influence conversion rates, length of stay, postoperative complications, and quality of the specimen or survival when the robotic platform is used.

Low preoperative platelets to predict postoperative liver dysfunction in patients with metastatic colorectal cancer undergoing liver resection.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 634-634
Author(s):  
Patrick Starlinger ◽  
Beata Herberger ◽  
Dietmar Tamandl ◽  
Stefan Stremitzer ◽  
Christine Brostjan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
High Risk ◽  
Postoperative Complications ◽  
Metastatic Colorectal Cancer ◽  
Liver Dysfunction ◽  
Postoperative Mortality ◽  
Platelet Counts ◽  
The Impact ◽  
Selection Of

634 Background: Despite improving median survival of metastatic colorectal cancer (mCRC) patients, chemotherapy (CTx) compromises liver function. Therefore, selection of patients who are of high risk to develop liver dysfunction (LD) after surgery is important. As platelets are of major importance in liver regeneration, we investigated the impact of preoperative platelet counts on the incidence of postoperative LD and its correlation to postoperative morbidity and mortality. Methods: Patients treated with liver resection for mCRC between January 2000 and December 2010 were eligible. LD was defined as bilirubin > 5 mg/dL or prothrombin time <50% within the first postoperative week. The association of preoperative platelets < 150 x 103/ml with LD, 90 days mortality and surgical complications was analyzed. Results: 518 patients with metastatic CRC cancer underwent liver resection, of whom 68% had received neoadjuvant CTx. 21% of all patients developed LD. Postoperative complications occurred in 13.5%. 10 patients died within 90 days after liver resection (1.9%). The incidence of LD and complications was significantly higher in patients with preoperative platelets < 150 x 103/ml (P=0.010, P=0.047). 90 days mortality was nearly 3 times higher in patients with reduced preoperative platelets (9.8% vs. 3.7%). Neoadjuvant CTx was associated with an increased rate of platelets < 150 x 103/ml (with CTx 25%, without CTx 17%; P=0.051), LD (with CTx 23%, without CTx 15%; P=0.029) and postoperative mortality (with CTx 5.3%, without CTx 2.5%). Conclusions: Patients with platelets < 150 x 103/ml have an increased incidence of postoperative LD, major complications and 90 days mortality. Using this simple routine parameter, it might be possible to select patients that could be better served with alternative treatments such as radiofrequency ablation. Furthermore, reduced platelet counts and the incidence of LD were more frequent in patients after neoadjuvant CTx resulting in an increased 90 days mortality. This suggests that patients after extensive CTx accompanied by low platelets are of high risk to suffer from postoperative complications and surgical treatment should be reconsidered.

scholarly journals The Effect of Short Term Aerobic Training on Serum Insulin and Insulin Resistance in Adult Obese Females

2020 ◽  
Author(s):  
Ashraf Amini ◽  
Zahra Mirakhori ◽  
Mojtaba Eizadi
Keyword(s):  
Insulin Resistance ◽  
Aerobic Training ◽  
Fasting Glucose ◽  
Serum Insulin ◽  
Exercise Group ◽  
P Value ◽  
Obese Women ◽  
Fat Percentage ◽  
Short Term ◽  
The Impact

Objective: Obesity is associated with inflammatory process and many different diseases. The objective of this study was to assess the impact of short term aerobic training on serum resistin and insulin resistance in adult obese women. Materials and Methods: In this quasi-experimental study, thirty untrained adult obese females matched for age 35-45 years old with body mass index (BMI) 30-36 kg/m2 were divided randomly into exercise (aerobic intervention; 6 weeks, 3 days/weekly, %55-70HRmax) and control (no training) groups. Pre and post-training of fasting blood samples were collected for measure serum resistin. Insulin resistance was calculated by HOMA-IR. Data were analyzed by the independent samples T-test. Results: Aerobic training resulted in significant decrease in BMI (32.1 (± 2.76) vs 31.6 (± 2.80) kg/m2, P-value: 0.023), body fat percentage (44.7 (± 4.55) vs 44 (± 4.33), P-value: 0.028) and fasting glucose (94 (± 8.9) vs 79 (± 5.8) mg/dl, P-value: 0.011) in exercise group. No changes were observed on insulin resistance (1.43 (± 1.11) vs 1.18 (± 0.57) HOMA-IR, P-value: 0.124) and serum resistin (2.20 (± 1.07) vs 1.58 (± 0.87) ng/ml P-value: 0.062) by training program. All variables remained unchanged in control subjects. Conclusion: Despite improving fasting glucose, a short-term aerobic training is not associated with anti-inflammatory property for obese females. Improved glucose could be likely attributed to other changes in metabolic markers in response to exercise training and further studies are necessary to clarify possible mechanisms

Impact of obesity and adiponectin signaling in patients with renal cell carcinoma: A potential mechanism for the obesity paradox.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 449-449
Author(s):  
Shintaro Narita ◽  
Ryuichi Ito ◽  
Mingguo Huang ◽  
Kazuyuki Numakura ◽  
Hiroshi Tsuruta ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Adipose Tissue ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Obesity Paradox ◽  
Lower Grade ◽  
Obese Patients ◽  
Total Adiponectin ◽  
Cancer Aggressiveness ◽  
The Impact

449 Background: Obesity increases the risk of renal cell carcinoma (RCC); however, obese patients experience longer survival than non-obese patients. The mechanism of this “obesity paradox” is unknown. We examined the impact of obesity, total adiponectin (AD) level, and intratumoral AD receptors expression on RCC aggressiveness and survival, and also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells with exogenous adiponectin stimulation. Methods: A total of 129 RCC patients treated with surgery were included in the analyses. Preoperative BMI, serum total adiponectin (AD) level, total AD secretion from perinephric adipose tissue, and intratumoral AD receptors mRNA and protein expression were analyzed. Caki-2 and 786- cells were used for in vitro functional analyses. Results: Overweight and obese patients had significantly lower grade cancers than normal patients in all patients and in those without metastasis (p = 0.003, and p = 0.027, respectively). Cancer-specific survival in overweight and obese patients was significantly better than in normal patients in all patients (p = 0.035). A weak inverse correlation existed between serum AD level and BMI in RCC patients (r = −0.344). Tumor size was slightly correlated with serum AD level, and high serum AD was significantly associated with poor overall survival in patients without metastasis (p = 0.035). The AD level of perinephric adipose tissue and intratumoral AdipoR1/R2 expression in tumors did not correlate with RCC aggressiveness and survival. Exogenous AD significantly enhanced proliferation, but not invasion or migration in 786-O and Caki-2 cells. Exogenous AD significantly inhibited starvation- and metformin-induced apoptosis, and up-regulated p-AMPK and Bcl-xL in these cells. Conclusions: Low BMI and high AD level are associated with cancer aggressive and poor survival in RCC patients treated surgically. AD modulates proliferation and apoptosis, which may underlie the “obesity paradox” of RCC.

The lung cancer obesity paradox: An analysis of 432,924 patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10578-10578
Author(s):  
Brittany Miles ◽  
James David Mackey
Keyword(s):  
Lung Cancer ◽  
Cancer Incidence ◽  
Radiation Treatment ◽  
Positive Impact ◽  
Obesity Paradox ◽  
Overweight And Obesity ◽  
Research Network ◽  
P Value ◽  
Lung Cancer Incidence ◽  
The Impact

10578 Background: The lung cancer obesity paradox is the unexpected inverse relationship between body mass index (BMI) and lung cancer mortality. While there is a growing body of evidence to support the existence of the obesity paradox in lung cancer, little is known about its magnitude and relationship to cancer incidence and its impact on outcomes from surgery, chemotherapy, immunotherapy, and radiation treatment. Methods: To evaluate the impact of obesity on lung cancer incidence, we used TriNetX, a global federated health research network providing access to electronic medical records (diagnoses, procedures, medications, laboratory values, genomic information) from approximately 69 Million patients in 49 large Healthcare Organizations. We evaluated 2 patient cohorts of 216,462 adult smokers aged 18 to 75 that were matched for age, race, gender, and ethnicity. One cohort of patients carried a diagnosis of overweight and obesity (ICD-10 code E66), while the other cohort required exclusion of those diagnoses. Results: We found a statistically significant decrease in lung cancer incidence for patients with obesity (1.407% vs 2.039%, p < 0.0001), in addition to superior overall survival (95.344% vs 92.039%, p < 0.0001). A subset analysis of patients who contracted lung cancer showed a statistically significant benefit in median survival in favor of patients with overweight and obesity (851 vs 602 days, p value 0.0009). Conclusions: These findings support the existence of the obesity paradox in lung cancer, and its positive impact on both lung cancer incidence and outcome.

Effect of Household Income on Short-Term Outcomes Following Cerebellopontine Angle Tumor Resection

2021 ◽  
Author(s):  
Vincent Huang ◽  
Stephen P. Miranda ◽  
Ryan Dimentberg ◽  
Kaitlyn Shultz ◽  
Scott D. McClintock ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Household Income ◽  
Cerebellopontine Angle ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Index Admission ◽  
P Value ◽  
Short Term ◽  
Significant Difference ◽  
The Impact

Abstract Objectives The objective of this study is to elucidate the impact of income on short-term outcomes in a cerebellopontine angle (CPA) tumor resection population. Design This is a retrospective regression analysis. Setting This study was done at a single, multihospital, urban academic medical center. Participants Over 6 years (from June 7, 2013, to April 24, 2019), 277 consecutive CPA tumor cases were reviewed. Main Outcome Measures Outcomes studied included readmission, emergency department evaluation, unplanned return to surgery, return to surgery after index admission, and mortality. Univariate analysis was conducted among the entire population with significance set at a p-value <0.05. The population was divided into quartiles based on median household income and univariate analysis conducted between the lowest (quartile 1 [Q1]) and highest (quartile 4 [Q4]) socioeconomic quartiles, with significance set at a p-value <0.05. Stepwise regression was conducted to determine the correlations among study variables and to identify confounding factors. Results Regression analysis of 273 patients demonstrated decreased rates of unplanned reoperation (p = 0.015) and reoperation after index admission (p = 0.035) at 30 days with higher standardized income. Logistic regression between the lowest (Q1) and highest (Q4) socioeconomic quartiles demonstrated decreased unplanned reoperation (p = 0.045) and decreasing but not significant reoperation after index admission (p = 0.15) for Q4 patients. No significant difference was observed for other metrics of morbidity and mortality. Conclusion Higher socioeconomic status is associated with decreased risk of unplanned reoperation following CPA tumor resection.

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