scholarly journals Impact of Excess Body Weight on Postsurgical Complications

2021 ◽  
Vol 37 (4) ◽  
pp. 287-297
Author(s):  
Lars Plassmeier ◽  
Mohammed K. Hankir ◽  
Florian Seyfried
Keyword(s):  
Body Weight ◽  
Risk Factor ◽  
Surgical Complications ◽  
Excess Body Weight ◽  
Low Grade ◽  
Complication Rates ◽  
Obese Patients ◽  
Upper Gi ◽  
Postsurgical Complications ◽  
Meta Analyses

<b><i>Background:</i></b> Obesity is considered a risk factor for postoperative complications as it can limit exposure to the operation field, thereby significantly prolonging surgery time. Obesity-associated comorbidities, such as low-grade systemic inflammation, impaired functional status, and type 2 diabetes, are independent risk factors for impaired anastomotic wound healing and nonsurgical site infections. If obesity itself is an independent risk factor for surgical complications remains controversial, but the reason for this is largely unexplored. <b><i>Summary:</i></b> A MEDLINE literature search was performed using the terms: “obesity,” “excess body weight,” and “surgical complications.” Out of 65,493 articles 432 meta-analyses were screened, of which 25 meta-analyses were on the subject. The vast majority of complex oncologic procedures in the field of visceral surgery have shown higher complication rates in obese patients. Meta-analyses from the last 10 to 15 years with high numbers of patients enrolled consistently have shown longer operation times, higher blood loss, longer hospital stay for colorectal procedures, oncologic upper gastrointestinal (GI) procedures, and pancreatic surgery. Interestingly, these negative effects seem not to affect the overall survival in oncologic patients, especially in esophageal resections. A selection bias in oncologic upper GI patients may have influenced the results with higher BMI in upper GI cancer to be a predictor for better nutritional and performance status. <b><i>Key Messages:</i></b> Contrary to bariatric surgery, only limited evidence indicated that site and type of surgery, the approach to the abdominal cavity (laparoscopic vs. open), institutional factors, and the type of perioperative care such as ERAS protocols may play a role in determining postsurgical complications in obese patients. The initial question remains therefore partially unanswered. Large nationwide register-based studies are necessary to better understand which aspects of obesity and its related comorbidities define it as a risk factor for surgical complications.

scholarly journals Health Benefits of Plant-Based Nutrition: Focus on Beans in Cardiometabolic Diseases

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 519
Author(s):  
Amy P. Mullins ◽  
Bahram H. Arjmandi
Keyword(s):  
Body Weight ◽  
Risk Factor ◽  
Disease Risk ◽  
Excess Body Weight ◽  
Low Grade ◽  
Protective Effects ◽  
Related Disease ◽  
Dietary Strategy ◽  
Health And Disease ◽  
Low Grade Inflammation

Cardiovascular disease (CVD) is the leading cause of death worldwide, claiming over 650,000 American lives annually. Typically not a singular disease, CVD often coexists with dyslipidemia, hypertension, type-2 diabetes (T2D), chronic system-wide inflammation, and obesity. Obesity, an independent risk factor for both CVD and T2D, further worsens the problem, with over 42% of adults and 18.5% of youth in the U.S. categorized as such. Dietary behavior is a most important modifiable risk factor for controlling the onset and progression of obesity and related disease conditions. Plant-based eating patterns that include beans and legumes support health and disease mitigation through nutritional profile and bioactive compounds including phytochemical. This review focuses on the characteristics of beans and ability to improve obesity-related diseases and associated factors including excess body weight, gut microbiome environment, and low-grade inflammation. Additionally, there are growing data that link obesity to compromised immune response and elevated risk for complications from immune-related diseases. Body weight management and nutritional status may improve immune function and possibly prevent disease severity. Inclusion of beans as part of a plant-based dietary strategy imparts cardiovascular, metabolic, and colon protective effects; improves obesity, low-grade inflammation, and may play a role in immune-related disease risk management.

The Obesity-associated Risk in Open and Endovascular Repair of Abdominal Aortic Aneurysm

2019 ◽  
Vol 25 (18) ◽  
pp. 2033-2037 ◽  
Author(s):  
Djordje Radak ◽  
Slobodan Tanaskovic ◽  
Mihailo Neskovic
Keyword(s):  
Risk Factor ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Treatment Option ◽  
Morbidly Obese ◽  
Complication Rates ◽  
Obese Patients ◽  
Invasive Treatment ◽  
Abdominal Aortic ◽  
The Subject

: The rising pandemic of obesity in modern society should direct attention to a more comprehensive approach to abdominal aortic aneurysm (AAA) treatment in the affected population. Although overweight patients are considered prone to increased surgical risk, studies on the subject did not confirm or specify the risks well enough. : Associated comorbidities inevitably lead to a selection bias leaning towards endovascular abdominal aortic repair (EVAR), as a less invasive treatment option, which makes it hard to single out obesity as an independent risk factor. The increased technical difficulty often results in prolonged procedure times and increased blood loss. Several smaller studies and two analyses of national registries, including 7935 patients, highlighted the advantages of EVAR over open repair (OR) of abdominal aortic aneurysm, especially in morbidly obese population (relative risk reduction up to 47%). On the other hand, two other studies with 1374 patients combined, concluded that EVAR might not have an advantage over OR in obese patients (P = 0.52). Obesity is an established risk factor for wound infection after both EVAR and OR, which is associated with longer length of stay, subsequent major operations, and a higher rate of graft failure. Percutaneous EVAR technique could present a promising solution to reducing this complication. : EVAR seems like a more feasible treatment option than OR for obese patients with AAA, due to lower overall morbidity and mortality rates, as well as reduced wound-related complication rates. However, there is a clear lack of high-quality evidence on the subject, thus future prospective trials are needed to confirm this advantage.

scholarly journals Excess body weight is an independent risk factor for severe forms of COVID-19

Metabolism ◽  
2021 ◽  
pp. 154703
Author(s):  
Léa Pietri ◽  
Roch Giorgi ◽  
Audrey Bégu ◽  
Manon Lojou ◽  
Marie Koubi ◽  
...  
Keyword(s):  
Body Weight ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Excess Body Weight

scholarly journals IV fosphenytoin in obese patients

2016 ◽  
Vol 7 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Sarah L. Clark ◽  
Megan R. Leloux ◽  
Ross A. Dierkhising ◽  
Gregory D. Cascino ◽  
Sara E. Hocker
Keyword(s):  
Body Weight ◽  
Adverse Events ◽  
Vital Signs ◽  
Drug Distribution ◽  
Retrospective Chart Review ◽  
Current Method ◽  
Liver Function Tests ◽  
Excess Body Weight ◽  
Obese Patients ◽  
Bonferroni Adjustment

AbstractBackground:Previous studies evaluated the disposition of IV phenytoin loading doses and found that obese patients had increased drug distribution into excess body weight, larger volumes of distribution, and longer half-lives when compared to their nonobese counterparts. We assess the safety and efficacy of fosphenytoin loading doses in patients with different body mass indices (BMIs).Methods:A retrospective chart review was conducted in 410 patients who received fosphenytoin. Patients were divided into 2 groups: BMI <30 (nonobese) and BMI ≥30 (obese). Patient demographics, fosphenytoin dose administered in mg/kg body weight, renal and liver function tests, fosphenytoin drug levels, and pre- and post-fosphenytoin administration vital signs were collected to assess for adverse events. Necessity of additional antiepileptic loading doses was used as a surrogate for clinical efficacy.Results:The median dose of fosphenytoin administered was 19 mg/kg (interquartile range 15–20). The most frequently encountered adverse event was hypotension, which occurred in 39% of the cohort. Using a Bonferroni adjustment for multiple comparisons, there were no differences in adverse events between the 2 groups. The need for additional antiepileptic loading doses was not different between the 2 groups (p = 0.07).Conclusions:The incidence of adverse events and the need for repeat loading antiepileptic medications was similar between the 2 groups. From our findings, the patients in our study did not receive empiric loading dose adjustments and the current method of loading fosphenytoin achieves similar outcomes, regardless of the patient's BMI.

scholarly journals Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases

2020 ◽  
Vol 33 (3) ◽  
pp. 297-306
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Rushikesh S. Joshi ◽  
Christopher P. Ames
Keyword(s):  
Risk Factor ◽  
Complication Rate ◽  
Surgical Complications ◽  
Deformity Correction ◽  
Neurological Deficits ◽  
Wedge Osteotomy ◽  
Medical Complication ◽  
Complication Rates ◽  
Cervical Deformity ◽  
Significant Difference

OBJECTIVEThe correction of severe cervicothoracic sagittal deformities can be very challenging and can be associated with significant morbidity. Often, soft-tissue releases and osteotomies are warranted to achieve the desired correction. There is a paucity of studies that examine the difference in morbidity and complication profiles for Smith-Petersen osteotomy (SPO) versus 3-column osteotomy (3CO) for cervical deformity correction.METHODSA retrospective comparison of complication profiles between posterior-based SPO (Ames grade 2 SPO) and 3CO (Ames grade 5 opening wedge osteotomy and Ames grade 6 closing wedge osteotomy) was performed by examining a single-surgeon experience from 2011 to 2018. Patients of interest were individuals who had a cervical sagittal vertical axis (cSVA) > 4 cm and/or cervical kyphosis > 20° and who underwent corrective surgery for cervical deformity. Multivariate analysis was utilized.RESULTSA total of 95 patients were included: 49 who underwent 3CO and 46 who underwent SPO. Twelve of the SPO patients underwent an anterior release procedure. The patients’ mean age was 63.2 years, and 60.0% of the patients were female. All preoperative radiographic parameters showed significant correction postoperatively: cSVA (6.2 cm vs 4.5 cm [preoperative vs postoperative values], p < 0.001), cervical lordosis (6.8° [kyphosis] vs −7.5°, p < 0.001), and T1 slope (40.9° and 35.2°, p = 0.026). The overall complication rate was 37.9%, and postoperative neurological deficits were seen in 16.8% of patients. The surgical and medical complication rates were 17.9% and 23.2%, respectively. Overall, complication rates were higher in patients who underwent 3CO compared to those who underwent SPO, but this was not statistically significant (total complication rate 42.9% vs 32.6%, p = 0.304; surgical complication rate 18.4% vs 10.9%, p = 0.303; and new neurological deficit rate 20.4% vs 13.0%, p = 0.338). Medical complication rates were similar between the two groups (22.4% [3CO] vs 23.9% [SPO], p = 0.866). Independent risk factors for surgical complications included male sex (OR 10.88, p = 0.014), cSVA > 8 cm (OR 10.36, p = 0.037), and kyphosis > 20° (OR 9.48, p = 0.005). Combined anterior-posterior surgery was independently associated with higher odds of medical complications (OR 10.30, p = 0.011), and preoperative kyphosis > 20° was an independent risk factor for neurological deficits (OR 2.08, p = 0.011).CONCLUSIONSThere was no significant difference in complication rates between 3CO and SPO for cervicothoracic deformity correction, but absolute surgical and neurological complication rates for 3CO were higher. A preoperative cSVA > 8 cm was a risk factor for surgical complications, and kyphosis > 20° was a risk factor for both surgical and neurological complications. Additional studies are warranted on this topic.

Übermäßiges Körpergewicht und Krebsrisiko

2020 ◽  
Vol 145 (14) ◽  
pp. 1006-1014
Author(s):  
Hans Scherübl
Keyword(s):  
Public Health ◽  
Ovarian Cancer ◽  
Multiple Myeloma ◽  
Body Weight ◽  
Risk Factor ◽  
Health Concern ◽  
Excess Body Weight ◽  
Healthy Weight ◽  
Public Health Concern ◽  
Associated Tumors

AbstractExcess body weight (EBW) is the second most important and potentially modifiable risk factor of cancer in Germany. The longer and the more excess body weight a person has, the higher the cancer risk. About 60 % of adult Germans have EBW (BMI ≥ 25.0 kg/m²) and more than 23 % are obese (BMI ≥ 30.0 kg/m²). Excess body weight is causally associated with colorectal, esophageal (adenocarcinoma), gastric (cardia), pancreatic, biliary, hepatocellular, kidney, thyroid, breast (postmenopausal), endometrial and ovarian cancer as well as multiple myeloma and meningioma. In recent years, more and more young adults (20–40 years) were diagnosed with EBW-associated tumors. People with EBW should be encouraged to join programs of cancer screening. Keeping a healthy weight is a major public health concern in Germany.

Excess Body Weight and Abdominal Hernia

2021 ◽  
pp. 1-8
Author(s):  
Ulrich A. Dietz ◽  
Omar Yusef Kudsi ◽  
Fahri Gokcal ◽  
Naseem Bou-Ayash ◽  
Urs Pfefferkorn ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Weight ◽  
Hernia Repair ◽  
Perioperative Complications ◽  
Total Body Weight ◽  
Abdominal Hernia ◽  
Excess Body Weight ◽  
Obese Patients ◽  
Hernia Surgery ◽  
Interdisciplinary Approaches

<b><i>Background:</i></b> Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. <b><i>Summary:</i></b> This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon’s expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25–30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. <b><i>Key Messages:</i></b> Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.

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.

scholarly journals COVID-19 Pandemi Sürecinde İdeal Vücut Ağırlığının Önemi

2021 ◽  
Vol 2 (2) ◽  
pp. 49-55
Author(s):  
Ayşe SALTEKİN ◽  
Nural ERZURUM ALİM
Keyword(s):  
Body Weight ◽  
Risk Factor ◽  
Disease Severity ◽  
Public Health Problem ◽  
Ideal Body Weight ◽  
Low Grade ◽  
Upper Respiratory Tract ◽  
Negative Consequences ◽  
Ideal Body ◽  
Viral Respiratory

The Importance of Ideal Body Weight in the COVID-19 Pandemia Period Obesity is an important public health problem that is common worldwide. With obesity, there is an increase in many diseases, including hypertension, cardiovascular diseases and diabetes, which are risk factors for COVID-19. In 2009, obesity was first defined as a risk factor for disease severity and mortality in infected individuals in the pandemic caused by H1N1 Influenza A virus affecting the upper respiratory tract. Then, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which emerged in 2012, was also found to be more common in individuals with obesity. These findings, which show that obesity increases the risk of disease severity and death in viral respiratory infections, suggest that obesity may increase the risk of another viral respiratory disease, COVID-19. Studies show that individuals with obesity suffer from COVID-19 disease more severely than individuals with normal body weight, and their intensive care unit needs are higher. Obesity is a risk factor for more severe COVID-19 disease due to a low-grade inflammatory condition and weakened immunity. There are studies in the literature showing that obesity as well as low body weight negatively affect the outcomes of COVID-19 disease. These studies revealed that COVID-19 patients with low body weight are at greater risk of mechanical ventilation and death. It has been observed that low body mass index and low body weight especially in infected elderly individuals increase the severity of COVID-19. Therefore, individuals having ideal body weight can prevent the negative consequences of COVID-19 disease. In addition, healthy nutrition plays an important role in the optimal functioning of the immune system and weight control. Keywords: COVID-19, obesity, underweight, immunity, nutrition

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