Body Mass Index is Predictive of Higher In-hospital Mortality in Patients Undergoing Laparoscopic Gastric Bypass but Not Laparoscopic Sleeve Gastrectomy or Gastric Banding

2014 ◽  
Vol 80 (10) ◽  
pp. 1039-1043 ◽  
Author(s):  
James Villamere ◽  
Alana Gebhart ◽  
Stephen Vu ◽  
Ninh T. Nguyen
Keyword(s):  
Body Mass Index ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Hospital Mortality ◽  
Gastric Banding ◽  
Body Mass ◽  
Laparoscopic Gastric Bypass ◽  
Complication Rates ◽  
Major Complications ◽  
The Impact

High body mass index (BMI) has been shown to be a factor predictive of increased morbidity and mortality in several single-institution studies. Using the University HealthSystem Consortium clinical database, we examined the impact of BMI on in-hospital mortality for patients who underwent laparoscopic gastric bypass, sleeve gastrectomy, and gastric banding between October 2011 and February 2014. Outcomes were examined within each procedure according to BMI groups of 35 to 49.9, 50.0 to 59.9, and 60.0 kg/m2 or greater. Outcome measures included in-hospital mortality, major complications, length of hospital stay, 30-day readmission, and cost. A total of 40,102 bariatric procedures were performed during this time period. For gastric bypass, there was an increase of in-hospital mortality (0.01 and 0.02 vs 0.34%; P < 0.01) and major complications (0.93 and 0.99 vs 2.62%; P < 0.01) in the BMI 60 kg/m2 or greater group. In contrast, sleeve gastrectomy and gastric banding had no association between BMI and rates of mortality and major complications. Cost increased with increasing BMI groups for all procedures. A strong association was found between BMI 60 kg/m2 or greater and higher in-hospital mortality and major complication rates for patients who underwent laparoscopic gastric bypass but not in patients who underwent sleeve gastrectomy or gastric banding.

Hyperparathyroidism and Vitamin D Deficiency after Laparoscopic Gastric Bypass

2008 ◽  
Vol 74 (6) ◽  
pp. 469-475 ◽  
Author(s):  
Ronald H. Clements ◽  
Kishore Yellumahanthi ◽  
Mary Wesley ◽  
Naveen Ballem ◽  
Kirby I. Bland
Keyword(s):  
Body Mass Index ◽  
Vitamin D ◽  
Gastric Bypass ◽  
Racial Differences ◽  
Body Mass ◽  
Laparoscopic Gastric Bypass ◽  
Serum Vitamin ◽  
Inverse Correlation ◽  
Limb Length ◽  
Roux Limb

Hyperparathyroidism (HPT) can occur after gastric bypass because of the alteration in vitamin D and calcium absorption. Adequate serum vitamin D concentrations have not been clearly defined in this patient population. Vitamin D (Vit D) and parathyroid hormone (PTH) were assessed 1 year after laparoscopic gastric bypass (LGB). The prevalence of HPT and Vit D deficiency were determined and their association was evaluated using Fisher's exact test. Ninety-three patients (aged 44 ± 1.1 years, 49.6 ± 0.67 kg/m2 body mass index, 79.6% female, 69.6% white) were evaluated. The prevalence of Vit D deficiency (less than 20 ng/mL) and HPT (greater than 65 pg/mL) was 23.6 per cent (n = 22) and 25.7 per cent (n = 28), respectively. Among patients with HPT, only eight of 28 (28.6%) had Vit D deficiency, and of those with Vit D deficiency, only eight of 22 (36.4%) had HPT. There was a weak inverse correlation (r = –0.37) between PTH and Vit D. Blacks are at higher risk for Vit D deficiency. There was no significant association between Vit D deficiency and HPT, Vit D deficiency and Roux limb length, or HPT and Roux limb length. After LGB, Vit D deficiency and hyperparathyroidism occur commonly. Body mass index and Roux limb length are not associated with these two conditions, but racial differences do exist. There is a weak inverse correlation between Vit D and PTH. Further research is needed to elucidate the causes, treatments, and significance of HPT after LGB.

Impact of Body Mass Index on Major Complications, Multiple Complications, In-hospital Mortality, and Failure to Rescue Following Esophagectomy for Esophageal Cancer

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yuki Hirano ◽  
Hidehiro Kaneko ◽  
Takaaki Konishi ◽  
Hidetaka Itoh ◽  
Satoru Matsuda ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Esophageal Cancer ◽  
Hospital Mortality ◽  
Body Mass ◽  
Failure To Rescue ◽  
Major Complications

scholarly journals Managing overlapping surgery: an analysis of 1018 neurosurgical and spine cases

2017 ◽  
Vol 127 (5) ◽  
pp. 1096-1104 ◽  
Author(s):  
Jian Guan ◽  
Andrea A. Brock ◽  
Michael Karsy ◽  
William T. Couldwell ◽  
Meic H. Schmidt ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Secondary Outcome ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Increased Risk ◽  
Neurosurgical Patients ◽  
Physical Classification ◽  
The Impact ◽  
Surgery Duration

OBJECTIVEOverlapping surgery—the performance of parts of 2 or more surgical procedures at the same time by a single lead surgeon—has recently come under intense scrutiny, although data on the effects of overlapping procedures on patient outcomes are lacking. The authors examined the impact of overlapping surgery on complication rates in neurosurgical patients.METHODSThe authors conducted a retrospective review of consecutive nonemergent neurosurgical procedures performed during the period from May 12, 2014, to May 12, 2015, by any of 5 senior neurosurgeons at a single institution who were authorized to schedule overlapping cases. Overlapping surgery was defined as any case in which 2 patients under the care of a single lead surgeon were under anesthesia at the same time for any duration. Information on patient demographics, premorbid conditions, surgical variables, and postoperative course were collected and analyzed. Primary outcome was the occurrence of any complication from the beginning of surgery to 30 days after discharge. A secondary outcome was the occurrence of a serious complication—defined as a life-threatening or life-ending event—during this same period.RESULTSOne thousand eighteen patients met the inclusion criteria for the study. Of these patients, 475 (46.7%) underwent overlapping surgery. Two hundred seventy-one patients (26.6%) experienced 1 or more complications, with 134 (13.2%) suffering a serious complication. Fourteen patients in the cohort died, a rate of 1.4%. The overall complication rate was not significantly higher for overlapping cases than for nonoverlapping cases (26.3% vs 26.9%, p = 0.837), nor was the rate of serious complications (14.7% vs 11.8%, p = 0.168). After adjustments for surgery type, surgery duration, body mass index, American Society of Anesthesiologists (ASA) physical classification grade, and intraoperative blood loss, overlapping surgery remained unassociated with overall complications (OR 0.810, 95% CI 0.592–1.109, p = 0.189). Similarly, after adjustments for surgery type, surgery duration, body mass index, ASA grade, and neurological comorbidity, there was no association between overlapping surgery and serious complications (OR 0.979, 95% CI 0.661–1.449, p = 0.915).CONCLUSIONSIn this cohort, patients undergoing overlapping surgery did not have an increased risk for overall complications or serious complications. Although this finding suggests that overlapping surgery can be performed safely within the appropriate framework, further investigation is needed in other specialties and at other institutions.

Results of Hallux Valgus Surgery in Diabetic Patients With Good Glycemic Control

2020 ◽  
Vol 41 (8) ◽  
pp. 945-953
Author(s):  
Gin Way Law ◽  
Kae Sian Tay ◽  
Akshay Padki ◽  
Khai Cheong Wong ◽  
Karen Ting Zhang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Glycemic Control ◽  
Hallux Valgus ◽  
Body Mass ◽  
Deformity Correction ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Patient Reported ◽  
The Impact ◽  
Reoperation Rates

Background: Literature is sparse on whether diabetes affects outcomes of hallux valgus surgery. With the rising global prevalence of diabetes and diabetes being an independent predictor of poorer outcomes, particularly in foot and ankle surgery, we aimed to investigate the impact of diabetes on the outcomes of hallux valgus surgery. Methods: We conducted a retrospective comparative cohort study of prospectively collected registry data of 951 feet in 721 patients who underwent surgery for symptomatic hallux valgus between 2007 and 2015 at our institution. All patients with diabetes were identified and matched with patients without diabetes for age, sex, and body mass index in a 1:2 ratio to construct the matched cohorts for analysis. Glycemic control in the diabetic cohort was assessed using preoperative HbA1c. The primary outcome measure was complication rates. Secondary outcomes were (1) deformity correction using the hallux valgus and intermetatarsal angles; (2) patient-reported outcomes using visual analog scale (VAS) for pain, Short Form–36 (SF-36) Physical and Mental Health subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) scores; (3) patient satisfaction; and (4) reoperation rates up to 2 years postoperatively. Forty diabetic patients were identified and matched to 80 nondiabetic patients. Although matching was only performed for age, sex, and body mass index, the diabetic and the nondiabetic cohorts were also similar in hallux valgus severity, preoperative scores, and types of procedures performed. Results: The mean preoperative HbA1c in our diabetic cohort was 7.1%. Both the diabetic and nondiabetic cohorts showed excellent AOFAS and VAS scores with no differences in degree of deformity correction, complication profiles, reoperation rates, outcome scores, and satisfaction at both 6 months and 2 years postoperatively. Conclusion: We believe stringent patient selection was key to reduced complication rates and good outcomes in diabetic patients. Well-selected diabetic patients remain suitable candidates for hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

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