The impact of body habitus on outcomes after aneurysmal subarachnoid hemorrhage: a Nationwide Inpatient Sample analysis

OBJECTIVEAlthough the prevalence of obesity is increasing rapidly both nationally and internationally, few studies have analyzed outcomes among obese patients undergoing cranial neurosurgery. The goal of this study, which used a nationwide data set, was to evaluate the association of both obesity and morbid obesity with treatment outcomes among patients with aneurysmal subarachnoid hemorrhage (SAH); in addition, the authors sought to analyze how postoperative complications for obese patients with SAH differ by the treatment modality used for aneurysm repair.METHODSClinical data for adult patients with SAH who underwent microsurgical or endovascular aneurysm repair were extracted from the Nationwide Inpatient Sample (NIS). The body habitus of patients was classified as nonobese (body mass index [BMI] < 30 kg/m2), obese (BMI ≥ 30 kg/m2 and ≤ 40 kg/m2), or morbidly obese (BMI > 40 kg/m2). Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality rate, complications, discharge disposition, and poor outcome as defined by the composite NIS-SAH outcome measure. Covariates included patient demographics, comorbidities (including hypertension and diabetes), health insurance status, the NIS-SAH severity scale, treatment modality used for aneurysm repair, and hospital characteristics.RESULTSIn total, data from 18,281 patients were included in this study; the prevalence of morbid obesity increased from 0.8% in 2002 to 3.5% in 2011. Obese and morbidly obese patients were significantly younger and had a greater number of comorbidities than nonobese patients (p < 0.001). Mortality rates for obese (11.5%) and morbidly obese patients (10.5%) did not significantly differ from those for nonobese patients (13.5%); likewise, no differences in neurological complications or poor outcome were observed among these 3 groups. Morbid obesity was associated with significantly increased odds of several medical complications, including venous thromboembolic (OR 1.52, 95% CI 1.01–2.30, p = 0.046) and renal (OR 1.64, 95% CI: 1.11–2.43, p = 0.01) complications and infections (OR 1.34, 95% CI 1.08–1.67, p = 0.009, attributable to greater odds of urinary tract and surgical site infections). Moreover, morbidly obese patients had higher odds of a nonroutine hospital discharge (OR 1.33, 95% CI 1.03–1.71, p = 0.03). Patients with milder obesity had decreased odds of some medical complications, including cardiac, pulmonary, and infectious complications, primarily among patients who had undergone coil embolization.CONCLUSIONSIn this study involving a nationwide administrative database, milder obesity was not significantly associated with increased mortality rates, neurological complications, or poor outcomes after SAH. Morbid obesity, however, was associated with increased odds of venous thromboembolic, renal, and infectious complications, as well as of a nonroutine hospital discharge. Notably, milder obesity was associated with decreased odds of some medical complications, primarily in patients treated with coiling.

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The Rise of Obesity among Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1710566 ◽

2020 ◽

Author(s):

Nequesha S. Mohamed ◽

Wayne A. Wilkie ◽

Ethan A. Remily ◽

Iciar M. Dávila Castrodad ◽

Mirlande Jean-Pierre ◽

...

Keyword(s):

Morbid Obesity ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

National Database ◽

Categorical Variables ◽

Morbidly Obese ◽

Obese Patients ◽

Total Knee ◽

Nonobese Patients

AbstractIn the United States, one-third of adults are considered obese, and demand for total knee arthroplasty (TKA) is expected to rise in these patients. Surgeons are reluctant to operate on obese patients, but it is important to understand how obesity has affected TKA utilization. This study utilizes a national database to evaluate incidence, demographics, outcomes, charges, and cost in nonobese, overweight, nonmorbidly obese, and morbidly obese TKA patients. We queried the National Inpatient Sample from 2009 to 2016 for primary TKA patients identifying 4,053,037 nonobese patients, 40,077 overweight patients, 809,649 nonmorbidly obese patients, and 428,647 morbidly obese patients. Chi-square was used to analyze categorical variables, and one-way analysis of variance was used to analyze continuous variables. Nonmorbidly obese and morbidly obese patients represented 23.2% of all TKAs. TKA utilization increased 4.1% for nonobese patients, 121.6% for overweight patients, 73.6% for nonmorbidly obese patients, and 83.9% for morbidly obese patients. Morbidly obese patients were younger (p < 0.001), female (p < 0.001), Black (p < 0.001), poor (p < 0.001), and utilized private insurance (p < 0.001). They also had the longest length of stay (p < 0.001) and the highest mortality rate (p < 0.001). More morbidly obese patients were discharged to other facilities (p < 0.001), and they had the highest rate of complications (p < 0.001). Patients with morbid obesity had the highest charges (p < 0.001), but overweight patients had the highest costs (p < 0.001). The results of this study demonstrate the rise in obese and morbidly obese patients seeking TKAs, which may be reflection of the obesity epidemic in America. Although TKA utilization has increased for morbidly obese patients, this body mass index (BMI) category also has the highest rates of charges and complications, suggesting morbid obesity to be a modifiable risk factor leading to worse surgical and economic outcomes. Obese patients undergoing TKA may benefit from preoperative optimization of their weight, in an effort to reduce the risk of adverse outcomes.

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Age and gender based prevalence of obesity in residents of Punjab, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191598 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1038 ◽

Cited By ~ 1

Author(s):

Satinderjit Singh ◽

Ravjit Kaur Sabharwal ◽

Jagminder Kaur Bajaj ◽

Indira R. Samal ◽

Megha Sood

Keyword(s):

Morbid Obesity ◽

Action Plan ◽

Age Groups ◽

Neurological Complications ◽

Overweight And Obesity ◽

Morbidly Obese ◽

Prevalence Of Obesity ◽

Study Population ◽

Gender Based ◽

And Gender

Background: Obesity is recognized as a chronic disease, associated with a variety of metabolic, cardiovascular and neurological complications. Prevalence of obesity is increasing worldwide, more so in the developing countries. It is affecting both sexes and all age groups. Body mass index BMI along with presence and severity of obesity associated complications are used to identify, successively increasing stages of obesity. The present study aims to study prevalence of overweight, obesity (stage 0,1,2) and morbid obesity in adult residents of Punjab state in an effort to determine burden of this lifestyle disorder in different age groups and sexes, so that a comprehensive action plan can be designed to target appropriate group with specific preventive measures .Methods: 1000 subjects were surveyed and labelled as non-obese, overweight, obese or morbid obese based on their BMI, presence and severity of obesity related complications. Point prevalence amongst different age groups of both sexes were determined and compared.Results: In study population 41.5% subjects were non-obese, 15.9% were overweight, 29.4% were obese and 13.2% were morbidly obese. The prevalence of all the 3 conditions (overweight, obesity and morbid obesity) increased with increasing age in both sexes. The prevalence was more among females of all age groups than males for ‘overweight’ and ‘obesity’. But gender based difference narrowed down with increasing severity of disease, such that female to male ratio reversed (<1) for morbid obesity. Moreover, peak prevalence of overweight and obesity were attained little later in females as compared to males. However, for morbid obesity peak prevalence is seen in same age group (40-49 years) in both sexes.Conclusions: Overweight and obesity are more prevalent among females of all age groups than males with peak prevalence achieved little later in females as compared to males. However, gender based differences in prevalence decreased as severity increased and morbid obesity was more prevalent among males than females.

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Towards Precision Health in Weight Reduction: Thematic Content Analysis of an Open-Ended Survey on Reasons Why Morbidly Obese Patients Want to Lose Weight.

10.21203/rs.3.rs-42745/v1 ◽

2020 ◽

Author(s):

Mazapuspavina Md-Ya ◽

Ilham Ameera Ismail ◽

Khasnur Abd Malek ◽

Khalid Yusoff ◽

Awang Bulgiba

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Content Analysis ◽

Weight Reduction ◽

Extensive Study ◽

Morbidly Obese ◽

Obese Patients ◽

Thematic Content Analysis ◽

Thematic Content ◽

The Impact

Abstract Background: Addressing individuals’ motivation to lose weight among patients with morbid obesity is an essential entity in weight reduction. Failures to shift motivation into weight loss actions are common. These could be contributed by the inadequacy to identify and subsequently address the key reasons, that are of particular concern to the patient' individual needs. We aimed to understand the motivations better and identify the reasons why morbidly obese patients attending hospital-based weight management programmes (WMP) wanted to lose weight. Methods: The study used a qualitative approach to analyze part of a quantitative questionnaire of a more extensive study to understand factors influencing weight loss among morbidly obese patients. We used thematic content analysis to analyze responses from a self-administered open-ended question "What is the main factor why you want to lose your weight?”. A total of 225 new patients attending obesity clinics in two tertiary hospitals responded to the questionnaire. Results: Patients’ mean BMI was 45.6±8.05 kg/m2. Four themes emerged for the reasons why morbidly obese patients wanted to lose weight. Health was the most commonly inferred theme (84%). Patients were concerned about the impact obesity had on their health. Overcoming obesity was seen as a reward not just for physical health, but also for their psychological wellbeing. Patients regard being functional to care for themselves, their family members, as well as their religious and career needs as the next most crucial theme (25.8%). Patients raised the theme appearance (12.9%), especially with regards to wanting to look and feel beautiful. The last theme was perceived stigmatization for being morbidly obese as they were mocked and laughed at for their appearance (3.1%).Conclusion: Patients with morbid obesity in this study had expressed their main personal motivational reasons to lose weight. Concerns about the impact of morbid obesity on health, physical, social and obligatory function, appearance and perceived stigma warrant detailed exploration by the managing health professionals. Identifying and addressing these unique personal motivations in a focused approach is vital at the beginning and throughout a weight reduction program in this unique group.

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Airway Tube Exchanger Techniques in Morbidly Obese Patients

Anesthesiology Research and Practice ◽

10.1155/2012/968642 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Danai Udomtecha

Keyword(s):

Morbid Obesity ◽

Airway Management ◽

Endotracheal Tube ◽

Surgical Procedures ◽

Morbidly Obese ◽

Obese Patients ◽

Tube Exchange ◽

Airway Tube

Morbidly obese patients may present a challenge during airway management. When airway tube exchange is required, it can even be more challenging than the primary intubation. With the increasing prevalence of morbid obesity over the years, there will be increasing numbers of these patients presenting for surgical procedures, including ones that require endotracheal tube exchanges. It is therefore important for anesthesiologists to be familiar with options and limitations of the airway tube exchanger techniques.

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Bariatric Surgery Normalizes Protein Glycoxidation and Nitrosative Stress in Morbidly Obese Patients

Antioxidants ◽

10.3390/antiox9111087 ◽

2020 ◽

Vol 9 (11) ◽

pp. 1087

Author(s):

Barbara Choromańska ◽

Piotr Myśliwiec ◽

Magdalena Łuba ◽

Piotr Wojskowicz ◽

Hanna Myśliwiec ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Oxidative Damage ◽

Nitrosative Stress ◽

High Specificity ◽

Morbidly Obese ◽

Obese Patients ◽

Plasma Tryptophan ◽

Nitrative Stress ◽

Specificity And Sensitivity

The results of recent studies indicate the key role of nitrosative stress and protein oxidative damage in the development of morbid obesity. Nevertheless, the effect of bariatric surgery on protein oxidation/glycation and nitrosative/nitrative stress is not yet known. This is the first study evaluating protein glycoxidation and protein nitrosative damage in morbidly obese patients before and after (one, three, six and twelve months) laparoscopic sleeve gastrectomy. The study included 50 women with morbid obesity as well as 50 age- and gender-matched healthy controls. We demonstrated significant increases in serum myeloperoxidase, plasma glycooxidative products (dityrosine, kynurenine, N-formyl-kynurenine, amyloid, Amadori products, glycophore), protein oxidative damage (ischemia modified albumin) and nitrosative/nitrative stress (nitric oxide, peroxy-nitrite, S-nitrosothiols and nitro-tyrosine) in morbidly obese subjects as compared to lean controls, whereas plasma tryptophan and total thiols were statistically decreased. Bariatric surgery generally reduces the abnormalities in the glycoxidation of proteins and nitrosative/nitrative stress. Noteworthily, in the patients with metabolic syndrome (MS+), we showed no differences in most redox biomarkers, as compared to morbidly obese patients without MS (MS−). However, two markers: were able to differentiate MS+ and MS− with high specificity and sensitivity: peroxy-nitrite (>70%) and S-nitrosothiols (>60%). Further studies are required to confirm the diagnostic usefulness of such biomarkers.

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Laparoscopic Anti-Reflux Surgery is Effective in Obese Patients with Gastro-Oesophageal Reflux Disease

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x205323 ◽

2007 ◽

Vol 89 (7) ◽

pp. 696-702 ◽

Cited By ~ 17

Author(s):

Vivien V Ng ◽

Michael I Booth ◽

Jane J Stratford ◽

Linda Jones ◽

J Sohanpal ◽

...

Keyword(s):

Reflux Disease ◽

Operative Time ◽

Oesophageal Reflux ◽

Morbidly Obese ◽

Obese Patients ◽

Indications For Surgery ◽

Body Habitus ◽

Oesophageal Reflux Disease ◽

Symptomatic Outcome ◽

Mean Time

INTRODUCTION Obesity has long been regarded as a risk factor for the development of gastro-oesophageal reflux disease (GORD). It has been claimed that surgical efficacy of laparoscopic anti-reflux operations is decreased in obese patients. The aim of this study was to assess whether laparoscopic anti-reflux surgery is effective in obese patients with GORD compared to non-obese patients. PATIENT AND METHODS A total of 366 patients (mean age 44 years; range, 12–86 years) underwent laparoscopic anti-reflux surgery between 1997–2003. Of these, 74 patients were considered obese; 58 patients had a body mass index (BMI) of 30–34 kg/m2 and 16 were classified as morbidly obese with a BMI ≥ 35 kg/m2. Pre-operative symptomatic scoring, indications for surgery, pH studies, operative times and complications were compared between obese and non-obese patients. Symptomatic outcome and Visick score between the two groups were assessed at 6 weeks, 6 months and 1 year following surgery. RESULTS Failure of medical treatment was the main reason for surgery in all groups. Operative time was longer in obese patients (mean time 93 min compared to 81 min; P = 0.0007), the main difficulty being gaining access because of their body habitus. All groups found the procedure to be effective in symptomatic outcome, 91% of obese patients compared to 92% of non-obese patients scored Visick I or II at 6 weeks' postoperatively. Similar Visick scoring was shown between the two groups at 6 months and 1 year, and in the morbidly obese group. CONCLUSIONS The outcome of laparoscopic anti-reflux surgery is similar between obese and non-obese patients with no trend towards a worse outcome in the obese or morbidly obese. Obesity should not be seen as a contra-indication, although it may be more technically challenging in this group of patients. Good results can be achieved in obese patients.

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Obesity Does Not Impact Outcomes for Appendicitis

The American Surgeon ◽

10.1177/000313481207800248 ◽

2012 ◽

Vol 78 (2) ◽

pp. 254-257 ◽

Cited By ~ 4

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.

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