scholarly journals The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study

2021 ◽  
Vol 10 (19) ◽  
pp. 4382
Author(s):  
Kellie Fusco ◽  
Campbell Thompson ◽  
Richard Woodman ◽  
Chris Horwood ◽  
Paul Hakendorf ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Health Outcomes ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Hospitalised Patients ◽  
Nutritional Data ◽  
The Impact

Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18–79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5–29.9 kg/m2), obese (BMI 30–39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02–1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11–1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.

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

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.

scholarly journals The Impact of Hypertension and Metabolic Syndrome on Nitrosative Stress and Glutathione Metabolism in Patients with Morbid Obesity

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Barbara Choromańska ◽  
Piotr Myśliwiec ◽  
Magdalena Łuba ◽  
Piotr Wojskowicz ◽  
Hanna Myśliwiec ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Morbid Obesity ◽  
Nitrosative Stress ◽  
Glutathione Metabolism ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Oxidized Glutathione ◽  
Metabolic Disturbances ◽  
No Formation ◽  
The Impact

In this pathbreaking study, we evaluated nitrosative stress in morbidly obese patients with and without metabolic syndrome. 62 women with class 3 obesity (BMI>40 kg/m2) were divided into three subgroups: obese patients (OB), obese patients with hypertension (OB+HYP), and obese patients with metabolic syndrome (OB+MS). In comparison to the lean patients, OB had increased levels of serum myeloperoxidase (MPO), plasma nitric oxide (NO), S-nitrosothiols, and peroxynitrite (ONOO−), as well as nitrotyrosine, while oxidized glutathione (GSSG) rose only in OB+HYP group. Interestingly, ONOO− was significantly higher in OB+HYP and OB+MS as compared to OB group, while MPO only in OB+MS group. OB+MS had greater nitrotyrosine and S-nitrosothiol values than OB+HYP. Moreover, peroxynitrite could differentiate OB from OB+HYP and OB+MS (AUC 0.9292; p<0.0001; 87.5% sensitivity, 90% specificity) as well as between OB and OB+MS group (AUC 0.9125; p<0.0001; 81.25% sensitivity, 83.33%). In conclusion, we showed that MPO activity, NO formation, and nitrosative damage to proteins parallel the progression of metabolic disturbances of obesity. Evaluation of ONOO− concentrations may help predict the development of hypertension and metabolic syndrome in patients with morbid obesity; however, longer-term studies are required for larger numbers of patients.

scholarly journals Morbid Obesity Is Associated With Worse Outcomes and Increased Inpatient Mortality in Patients With Alcohol Induced Acute Pancreatitis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A22-A22
Author(s):  
Hafeez Shaka ◽  
Essam Rashad ◽  
Ikechukwu Achebe ◽  
Jennifer Chiagoziem Asotibe ◽  
Emmanuel Palomera ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Acute Pancreatitis ◽  
Negative Impact ◽  
The United States ◽  
Hospital Charges ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Inpatient Mortality ◽  
Nationwide Inpatient Sample Database ◽  
The Impact

Abstract Introduction: The prevalence of obesity in the United States is rising. Obesity is a known comorbidity with various health impacts. Alcohol is a common etiology for acute pancreatitis. Obesity is known to be associated with liver dysfunction. It is unclear to what extent the degree of obesity affects patients with alcohol induced acute pancreatitis (AAP), as nationally representative data are lacking. This study aimed to ascertain the impact of morbid obesity on outcomes of patients with alcohol induced pancreatitis. Methods: Data was obtained from the Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with a principal diagnosis of AAP were included. This cohort was divided based on presence of comorbid obesity into nonobese patients, mild-moderately obese patients (MMO) (BMI: 30.0 - 39.9) and morbidly obese patients (MO) (BMI &gt;/=40.0). Primary outcome was inpatient mortality. Secondary outcomes included length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, sepsis, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 143650 hospitalizations were principally for AAP, with 5.5% and 2.7% of these patients classified as having MMO and MO, respectively. In MO patients, there was increased odds of mortality (aOR=2.99, 95% CI: 1.509 - 5.917, p=0.002) when compared with patients who were nonobese. There was no difference in mortality in patients with MMO (aOR 0.88 95% CI: 0.383 - 2.026, p=0.765) when compared with the nonobese group. MO patients had increased mean LOS of 1.1 days (95% CI: 0.7 - 1.6, p&lt;0.001) as well as THC of $14481 (95% CI: 7894 - 21068, p&lt;0.001), increased odds of hypocalcemia (aOR=1.77, 95% CI: 1.302 - 2.392, p&lt;0.001), sepsis (aOR=1.84, 95% CI: 1.183 - 2.873, p=0.007), AKI (aOR=1.55, 95% CI: 1.257 - 1.912, p&lt;0.001). Conclusion: Morbid obesity has a negative impact on outcomes of patients with AAP. Efforts should be channeled towards promoting alcohol cessation in at-risk patients as a preventative measure, as well as closer monitoring of hospitalized patients with morbid obesity to mitigated these adverse events.

scholarly journals Morbid Obesity Does Not Impact Mortality, Rate of Endoscopy in Patients With Biliary Acute Pancreatitis: A US Nationwide Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A34-A35
Author(s):  
Hafeez Shaka ◽  
Emmanuel Palomera-Tejeda ◽  
Ikechukwu Achebe ◽  
Jennifer Chiagoziem Asotibe ◽  
Garima Pudasaini ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Septic Shock ◽  
Acute Pancreatitis ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Morbidly Obese ◽  
Nationwide Inpatient Sample Database ◽  
Significant Difference ◽  
Biliary Acute Pancreatitis ◽  
The Impact

Abstract Introduction: Morbid obesity (MO) is associated with increased mortality in various conditions including acute pancreatitis. Interventions are challenging in patients with MO due to higher prevalence of comorbidities that may affect airway and cardiopulmonary management. Biliary acute pancreatitis (BAP) is the most common etiology for acute pancreatitis in the US. Population-based studies on the effect of obesity on biliary acute pancreatitis are lacking. This study aimed to assess the impact of MO on outcomes of patients with BAP. Methods: Data was obtained from the Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with a principal diagnosis of BAP were included. This cohort was divided based on BMI into nonobese patients (BMI &lt;30) and morbidly obese (MO) patients (BMI &gt;/=40.0). Patients with BMI between 30.0–39.9 were excluded. Primary outcome was inpatient mortality. Secondary outcomes included rate of endoscopic procedures, length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, septic shock, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 128995 hospitalizations were principally for BAP, with 75.7% and 12.0% of these patients classified as nonobese and MO respectively. There was a significantly higher proportion of females (66.1 vs 54.5%, p&lt;0.001) and lower mean age (50.1 vs 58.7 years, p&lt;0.001) in patients with MO. There was no significant difference in adjusted odds of mortality (aOR=1.34, 95% CI: 0.88 - 2.03, p=0.174), or rate of endoscopy (aOR 1.00 95% CI: 0.91 - 1.11, p=0.958), in MO compared with patients who were nonobese. However, MO patients had increased mean LOS of 0.8 days (95% CI: 0.5 - 1.0, p&lt;0.001), increased mean THC of $10760 (95% CI: 7077 - 14442, p&lt;0.001), increased odds of hypocalcemia (aOR=1.60, 95% CI: 1.22 - 2.09, p=0.001), septic shock (aOR=2.13, 95% CI: 1.39 - 3.25, p&lt;0.001), and AKI (aOR=1.48, 95% CI: 1.30 - 1.68, p&lt;0.001). Conclusion: Even though we did not find any significative difference in mortality, patients with MO appear to have and increased LOS and THC, as well as more complications like septic shock, AKI, and hypocalcemia. This calls for a greater recognition of this association for further research studies and to recognize this potential association during clinical practice.

Health-related quality of life in morbid obesity: the impact of laparoscopic sleeve gastrectomy

Open Medicine ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. 374-381 ◽  
Author(s):  
Radka Bužgová ◽  
Marek Bužga ◽  
Pavol Holéczy
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Morbid Obesity ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
World Health ◽  
Morbidly Obese ◽  
Obese Patients ◽  
The Impact

AbstractOur aim in this prospective study was to determine the impact of laparoscopic sleeve gastrectomy on the quality of life of patients with morbid obesity in comparison with population standards. The study evaluated 76 morbidly obese patients who underwent laparoscopic sleeve gastrectomy. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was used to evaluate quality of life in the following four areas: physical health, mental health, social relations, and environment. Patients completed the questionnaire before their planned operation and again 3 and 6 months after surgery. Compared with the population standard, patients with morbid obesity had significantly lower quality of life scores in the physical and mental health domains, including on independent questions related to of overall health and quality of life (p<0.001). Women scored lower on indicators of mental health than men. Three and 6 months following surgery a significant trend of body mass index (BMI) reduction was seen, as well as increased quality of life in all indicated areas (p<0.001). Laparoscopic sleeve gastrectomy treatment in morbidly obese patients reduced BMI on a long-term basis, a change seen as early as 3 months after surgery. By 6 months after surgery, patients had the same quality of life scores as the reference population.

scholarly journals Understanding the Impact of Obesity on Short-term Outcomes and In-hospital Costs After Instrumented Spinal Fusion

Neurosurgery ◽  
2015 ◽  
Vol 78 (1) ◽  
pp. 127-132 ◽  
Author(s):  
Dominique M. Higgins ◽  
Grant W. Mallory ◽  
Ryan F. Planchard ◽  
Ross C. Puffer ◽  
Mohamed Ali ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Spinal Fusion ◽  
Cost Of Care ◽  
Wound Complications ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Degenerative Spine ◽  
Degenerative Spine Disease ◽  
The Impact ◽  
Spine Disease

Abstract BACKGROUND: Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion. OBJECTIVE: To evaluate the impact of obesity on resource utilization and early complications in patients undergoing surgery for degenerative spine disease. METHODS: A single-institution retrospective analysis was conducted on patients with degenerative spine disease requiring instrumentation between 2008 and 2012. The 801 identified patients were grouped based on a body mass index (BMI) of &lt;30 (nonobese, n = 478), ≥30 and &lt;40 (obese, n = 283), and alternatively BMIs of ≥40 (morbidly obese, n = 40). Baseline characteristics, surgical outcomes and requirements, complications, and cost were compared. Logistic and linear regression analyses were used to determine the strength of association between obesity and outcomes for categorical and continuous data, respectively. RESULTS: Significant differences were found in comorbidities between cohorts. Multivariate analysis revealed significant associations between obesity and longer anesthesia times (30 minutes, P = .008), and surgical times (24 minutes, P = .02). Additionally, there was a 2.8 times higher rate of wound complications in obese patients (4.2% vs 1.5, P = .03), and 2.5 times higher rate of major medical complications (7.8% vs 3.1, P = .01). Morbid obesity resulted in a 10 times higher rate of wound complications (P &lt; .001). Morbid obesity resulted in a $9078 (P = .005) increase in overall cost of care. CONCLUSION: Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of comorbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.

Is ICD-9 Coding of Morbid Obesity Reliable in Patients Undergoing Total Knee Arthroplasty?

2018 ◽  
Vol 31 (10) ◽  
pp. 934-939 ◽  
Author(s):  
Jaiben George ◽  
Nipun Sodhi ◽  
Hiba Anis ◽  
Anton Khlopas ◽  
Joseph Moskal ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Total Knee Arthroplasty ◽  
Sensitivity And Specificity ◽  
Knee Arthroplasty ◽  
International Classification Of Diseases ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Primary Tkas ◽  
Total Knee ◽  
The Impact

AbstractMorbid obesity is considered to have a stronger association with complications after total knee arthroplasty (TKA). Although the impact of obesity coding errors has been previously reported, the extent of coding inaccuracies with respect to morbid obesity is unclear. Therefore, the purpose of this study was to assess (1) the utility of coding in identifying morbid obesity and (2) the effects of morbid obesity on 90-day complications after TKA when morbid obesity was defined by both body mass index (BMI) and International Classification of Diseases 9th edition (ICD-9) coding. A total of 18,030 primary TKAs performed at a single institution from 2004 to 2014 were identified. Patients were defined as morbidly obese based on ICD-9 codes or by BMI recorded in the electronic medical record (EMR). Patients were defined as obese (ICD-9 codes 278.0, 278.00, 278.01, 278.03, 649.10–14, 793.91, V85.30–39, V85.41–45, V85.54) or morbidly obese (278.01, V85.41–45) by ICD-9 codes. Patient EMRs were also reviewed to identify obese and morbidly obese patients (BMI cutoffs of 30 and 40 kg/m2, respectively). Complications between the cohorts were compared. Sensitivity and specificity were also calculated. Among the 2,880 surgeries performed in morbidly obese patients, a code for obesity was present in 1,618 (56.2%) surgeries, but only 57.9% (937) of these patients had a code specific for morbid obesity, with the rest having a code not specifying morbid obesity. The sensitivity and specificity of obesity coding were 34.5 and 96.0%, while that of morbid obesity were 32.5 and 96.7%, respectively (area under curve: 0.65 vs. 0.65, p = 0.214). A higher rate of complications was noted when patients were defined as morbidly obese by ICD-9 as when defined by EMR-reported BMI. Although morbidly obese patients are more likely to have a code for obesity compared with obese patients, these patients may not be correctly identified as morbidly obese due to a lack of specificity in the codes. These errors may lead to inadequate reimbursements, and may also overestimate the effect of morbid obesity on complications.

scholarly journals Impact of Morbid Obesity on Patients With Hypertriglyceridemia Induced Acute Pancreatitis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A16-A16
Author(s):  
Garima Pudasaini ◽  
Hafeez Shaka ◽  
Achebe Ikechukwu ◽  
Jennifer Chiagoziem Asotibe ◽  
Emmanuel Palomera Tejeda ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Septic Shock ◽  
Acute Pancreatitis ◽  
Length Of Hospital Stay ◽  
Multivariate Regression Analysis ◽  
Hospital Charges ◽  
Morbidly Obese ◽  
Biliary Stones ◽  
Nationwide Inpatient Sample Database ◽  
The Impact

Abstract Introduction: Obesity is reportedly associated with worse outcome in patients with acute pancreatitis (AP). However, AP has varying etiologies. Hypertriglyceridemia induced acute pancreatitis (HTGP) has sociodemographic variations compared to AP from biliary stones or alcohol. This study aimed to determine the impact of obesity on outcomes of patients with HTGP. Methods: This was a retrospective cohort study of the combined Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with HTGP were included. This cohort was divided based on presence of comorbid obesity into three groups- patients without obesity, mild-moderate obesity (MMO) (BMI: 30.0 - 39.9) and morbid obesity (MO) (BMI &gt;=40.0). Primary outcome was inpatient mortality. Secondary outcomes included length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, sepsis, septic shock, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 104,465 hospitalizations were principally for HTGP, accounting for 18.2% of patients with acute pancreatitis during the study period. Of the patients with HTGP, 13.7% and 10.9% of these patients classified as having MMO and MO respectively. Patients with obesity were significantly younger than patients without obesity. In patients with MO, there was higher odds of mortality (aOR=1.83, 95% CI: 1.090 – 3.083, p=0.022), while there was no difference in mortality in patients with MMO (aOR 1.09 95% CI: 0.609 – 1.940, p=0.777), both compared with patients without obesity. Patients with MO had increased mean LOS of 0.5 days (95% CI: 0.3 – 0.7, p&lt;0.001) as well as increased THC of $3977 (95% CI: 1467 – 6487, p=0.002) compared to those without obesity. There was no difference in mortality, THC and LOS in patients with MMO. Morbidly obese patients also had increased odds of septic shock (aOR=2.27, 95% CI: 1.297 – 3.972, p=0.007), AKI (aOR=1.28, 95% CI: 1.120 – 1.459, p&lt;0.001), and ARF (aOR=1.94, 95% CI: 1.491 – 2.524, p&lt;0.001). Conclusion: Morbid obesity is associated with higher mortality and poor outcomes in patient with hypertriglyceridemia induced pancreatitis.

Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borghi ◽  
J.G Wang ◽  
A.V Rodionov ◽  
M Rosas ◽  
I.S Sohn ◽  
...  
Keyword(s):  
Combination Therapy ◽  
South Korea ◽  
Health Outcomes ◽  
Clinical Outcomes ◽  
Funding Source ◽  
Combination Therapies ◽  
Private Company ◽  
Treatment Pathways ◽  
Single Pill ◽  
The Impact

Abstract Background It is well established that single pill combination (SPC) therapies have the potential to improve patient adherence versus multi-pill regimens, thereby improving blood pressure control and clinical outcomes in populations with hypertension. Purpose To develop a microsimulation model, capturing different treatment pathways, to project the impact on clinical outcomes of using single pill combination therapies for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico). Methods The model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices [CTP], single drug with dosage titration first then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills [FCC] and combination therapy in the form of a single pill [SPC]. Model inputs were derived from Global Burden of Disease 2017 dataset, including demographics, health status/risk factors, transition probabilities and treatment attributes/healthcare utilization, and the model incorporated real-world challenges to healthcare delivery such as access to care, SBP measurement error, adherence and therapeutic inertia. Simulated outcomes of mortality, incidence of chronic kidney disease (CKD), stroke and ischemic heart disease (IHD), and disability-adjusted life years (DALYs) due to these conditions were estimated for population of 1,000,000 simulated patients for each treatment pathway and country. Results SPC therapy was projected to improve health outcomes over SLGS, FCC and CTP over 10 years in all five countries. SPC was forecast to reduce mortality by 5.4% (Italy), 4.9% (Russia), 4.5% (China), 2.3% (South Korea) and 3.6% (Mexico) versus CTP and showed greater projected reductions in mortality than SLGS and FCC. DALYs were projected to be reduced with SPC therapy by between 5.7% (Italy) and 2.2% (South Korea) compared with CTP and reductions in the incidence of clinical events were also projected with SPC therapy, with decreases in the range of 11.5% (Italy) to 4.9% (South Korea) versus CTP. Conclusions Ten-year projections of clinical outcomes associated with different anti-hypertensive treatment pathways in five countries indicated that both combination therapies (FCC and SPC) are likely to reduce the disease burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Sanofi, Gentilly, France

scholarly journals Effect of Obesity on Clinical Failure of Patients Treated with Beta-Lactams

2021 ◽  
Author(s):  
Nathan A Pinner ◽  
Natalie G Tapley ◽  
Katie E Barber ◽  
Kayla R Stover ◽  
Jamie L Wagner
Keyword(s):  
Treatment Failure ◽  
Clinical Outcomes ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Definitive Treatment ◽  
Therapeutic Drug ◽  
Obese Patients ◽  
Definitive Therapy ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a beta-lactam (BL) have worse clinical outcomes compared to non-obese patients and to identify if therapeutic drug monitoring (TDM) may be beneficial. Methods This multi-center, retrospective cohort included hospitalized adults admitted from July 2015-July 2017 treated with a BL as definitive monotherapy against a Gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required &gt;1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): non-obese (BMI ≤29.9 kg/m 2) and obese (BMI ≥30.0 kg/m 2). The primary outcome was clinical treatment failure, and secondary were hospital length of stay (LOS), inpatient all-cause mortality, and 30-day all-cause readmission. Results There were 257 (43.6%) obese patients and 332 (56.4%) non-obese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by 3 rd generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) non-obese patients (p&lt;0.001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than non-obese patients (p=0.002), but no differences were found for all-cause mortality (p=0.117) or infection-related readmission (0=0.112). Conclusions Obese patients treated with BLs have higher rates of treatment failure and longer hospitalization periods than non-obese patients. Future studies are needed to assess the impact of TDM and specific dosing recommendations for targeted infection types.

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