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.

Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

2020 ◽  
Vol 32 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Care ◽  
Body Mass ◽  
Care Facility ◽  
Older Age ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Patient Reported ◽  
The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index

2012 ◽  
Vol 8 (4) ◽  
pp. 375-380 ◽  
Author(s):  
Ricardo Cohen ◽  
Pedro Paulo Caravatto ◽  
Jose Luis Correa ◽  
Patricia Noujaim ◽  
Tarissa Zanata Petry ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Glycemic Control ◽  
Body Mass ◽  
Bypass Surgery ◽  
Diabetic Patients ◽  
Low Body Mass Index ◽  
Jejunal Bypass

scholarly journals Assessment of diabetes self-management among diabetic patients attending Jeddah Care Center for Diabetes, Saudi Arabia.

2021 ◽  
Author(s):  
Reem Alqahtani ◽  
Sami Alzahrani ◽  
Moneerah Alhemedi ◽  
Asya Hawsa ◽  
Sarah Idris ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Saudi Arabia ◽  
Glycemic Control ◽  
Healthy Eating ◽  
Care Center ◽  
Self Management ◽  
Diabetic Patients ◽  
Normal Body Mass Index ◽  
The Impact

Abstract Objectives:To assess the levels and the associated demographic factors with diabetic self- management (DSM) among diabetic patients in Saudi Arabia. The impact of implementing DSM practices on glycemic control was additionally investigated.Results:The responses of 349 patients were analyzed (51.0% males and 37.2% obese). The median (IQR) raw DSMS score was 187 (165-205). Higher DSMS scores were reported for young adults (aged 20-29 years), insulin users, employed patients, as well as those with normal body mass index values and normal HbA1c results compared to their counterparts. Low HbA1c values were linearly associated with high scores of the healthy eating (β = -0.014, p=0.018) and physical activity subscales (β = 90-0.009, p=0.042).Keywords : Self-management; diabetes; glycemic control; Saudi Arabia.

scholarly journals Multiple Sclerosis Wellness Shared Medical Appointment Model: A Pilot Study

2021 ◽  
Author(s):  
Justin R. Abbatemarco ◽  
Jeffrey A. Cohen ◽  
Belinda L. Udeh ◽  
Sunakshi Bassi ◽  
Mary R. Rensel
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Body Mass Index ◽  
Health Care Utilization ◽  
Body Mass ◽  
Private Insurance ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Patient Reported ◽  
The Impact

Abstract Background: Shared medical appointments (SMAs) are group medical visits combining medical care and patient education. We examined the impact of a wellness-focused pilot SMA in a large multiple sclerosis (MS) clinic. Methods: We reviewed data on all patients who participated in the SMA from January 2016 through June 2019. Data were collected 12 months pre/post SMA; included demographics, body mass index, patient-reported outcomes, and health care utilization; and were compared using Wilcoxon rank sum test. Results: Fifty adult patients (mean ± SD age, 50.1 ± 12.3 years) attended at least one MS wellness SMA. Most patients had private insurance (50%), and 26% had Medicaid coverage. The most common comorbidity was depression/anxiety (44%). Pre/post SMA outcomes showed a small but significant reduction in body mass index (30.2 ± 7.3 vs 28.8 ± 7.1, P = .03), and Patient Health Questionnaire-9 scores decreased from 7.3 ± 5.5 to 5.1 ± 5.6 (P = .001). The number of emergency department visits decreased from 13 to two (P = .0005), whereas follow-up visits increased with an attendees’ primary care provider from 19 to 41 (P &lt; .001), physical therapist from 15 to 27 (P = .004), and psychologist from six to 19 (P = .003). Conclusions: This pilot MS wellness SMA was associated with improved physical and psychological outcomes. There was increased, lower-cost health care utilization with reduced acute, high-cost health care utilization, suggesting that SMAs may be a cost-effective and beneficial method in caring for patients with MS.

scholarly journals Control of Type II Diabetes, Its Relationship with Obesity and Basal Metabolic Rate

2019 ◽  
Vol 1 (1) ◽  
pp. 2-7
Author(s):  
Faiza Kamal ◽  
Rozina Arshad ◽  
Bilal Bin Younis ◽  
Rashid Ahmed ◽  
Zakia Noureen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Glycemic Control ◽  
Metabolic Rate ◽  
Body Mass ◽  
Basal Metabolic Rate ◽  
Glycated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Normal Body Mass Index ◽  
Sample Population

Background: The prevalence of T2DM is around 7-10%. Control of diabetes and factors influencing it in thirdworld countries need to be clearly defined as most of the people have poor glycemic control. Methods: A cross sectional study was conducted and purposive sampling was done to collect data for 5 months. Atotal of 766 type 2 diabetic patients were enrolled who visited SiDER (Sakina Institute of Diabetes and EndocrineResearch Center) at Shalamar Hospital, Lahore, Pakistan. Only pre-diagnosed diabetic subjects with a random bloodglucose of more than 200mg/dl at two occasions and fasting blood glucose levels more than 126mg/dl were includedin the study. Variables like Body Mass Index (BMI), Glycated Hemoglobin (HbA1c) and Basal Metabolic Rate(BMR) were recorded. The data was analyzed by SPSS 22 version. Results: A total of 766 diabetics were recruited in the study out of which 40.3% were male and 59.7% werefemales. The mean age was 48.72±10.43 years. Out of these 53.39% were obese, 32.64% were overweight and only13.97% had a normal body mass index BMI). HbA1c levels in the sample population showed that only 13.05% hadvery healthy control i.e. 7% or less. There was a positive co-relation between Body Mass Indexand glycemiccontrol. However there was no statistically significant relation between Basal Metabolic Rateand glycemic control. Conclusion: People with high Body Mass Index were found to have suboptimal glycemic control. It was alsoobserved that higher percentage of diabetic patients fall in age group of 41-55 years. More powerful studies areneeded to establish a relation between glycated hemoglobin and Basal Metabolic Rate.

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.

The Effects of Patient Occupation, Hobbies, and Body Mass Index on Kneeling after Total Knee Arthroplasty

2019 ◽  
Author(s):  
Karim G. Sabeh ◽  
Victor H. Hernandez ◽  
Wayne B. Cohen-Levy ◽  
Alvin Ong ◽  
Fabio Orozco ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Univariate Analysis ◽  
Substantial Impact ◽  
Significant Difference ◽  
Patient Reported ◽  
Total Knee ◽  
The Impact

AbstractA common patient concern after total knee arthroplasty (TKA) is the ability to kneel. Kneeling may have a substantial impact on the patients' ability to perform many activities of daily living, occupations, and hobbies. The purpose of this study was to quantify the percentage of patients able to kneel after TKA after 2 years and to evaluate preoperative patient characteristics that influence the patient's perceived ability to kneel after TKA such as obesity, occupation, and hobbies. We retrospectively assessed a cohort of 404 patients who underwent primary TKA with patellar resurfacing. We assessed the impact of patient hobbies, occupation, employment status, and body mass index (BMI) on the kneeling capacity and patient-reported satisfaction. Univariate analysis was performed using Fisher's exact test, and multivariate analysis was performed using logistic regression with multiple imputations. A total of 404 patients were included. Sixty percent of patients were unable to kneel after TKA. Males (p < 0.001) and patients with occupations or hobbies requiring kneeling (p < 0.05) were more likely to kneel after surgery. We identified an inverse relationship between BMI and the ability to kneel. No correlation was found between duration and frequency of kneeling relative to patient-reported ease or difficulty with kneeling. Patient-reported factors that prevented patients from kneeling were pain, physical inability, and fear of damaging the prosthesis. Patient education may be helpful in improving patient expectations about kneeling after surgery. A small but significant difference in subjective patient satisfaction was observed when comparing patients able to kneel with those unable to kneel.

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.

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