Comparing performance of McGrath MAC videolaryngoscope in morbidly obese and 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.

Download Full-text

Is it More Difficult to Cannulate the Right Internal Jugular Vein in Morbidly Obese Patients than in Nonobese Patients?

Obesity Surgery ◽

10.1007/s11695-008-9590-z ◽

2008 ◽

Vol 18 (9) ◽

pp. 1157-1159 ◽

Cited By ~ 13

Author(s):

Masako Fujiki ◽

Cosmin G. Guta ◽

Hendrikus J. M. Lemmens ◽

John G. Brock-Utne

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Morbidly Obese ◽

Obese Patients ◽

The Right ◽

Nonobese Patients

Download Full-text

The Use of Stems for Morbid Obesity in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1681078 ◽

2019 ◽

Vol 32 (07) ◽

pp. 607-610 ◽

Cited By ~ 1

Author(s):

Blake J. Schultz ◽

Malcolm R. DeBaun ◽

James I. Huddleston

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

High Risk Patient ◽

Morbidly Obese ◽

Obese Patients ◽

Limited Data ◽

Implant Fixation ◽

Knee Motion ◽

Total Knee ◽

Nonobese Patients

AbstractMorbidly obese patients undergoing total knee arthroplasty have worse functional outcomes and implant survival, and increased revision rates compared with nonobese patients. In addition to increased medical comorbidities and difficult exposure, increased stress on the tibial implant and altered kinematics of knee motion contribute to aseptic loosening and medial collapse. Increased implant fixation, including use of a stemmed tibial implant, may be a way to help avoid these complications. While there is limited data on tibial stems in the morbidly obese patients specifically, cemented stemmed tibial implants should be strongly considered in these patients, especially if bone quality is poor. The initial increased cost of a stemmed implant can be justified in this high-risk patient population to minimize the risk of costly revisions related to compromised tibia component fixation.

Download Full-text

ED50and ED95of Intrathecal Bupivacaine in Morbidly Obese Patients Undergoing Cesarean Delivery

Anesthesiology ◽

10.1097/aln.0b013e318209a92d ◽

2011 ◽

Vol 114 (3) ◽

pp. 529-535 ◽

Cited By ~ 47

Author(s):

Brendan Carvalho ◽

Jeremy Collins ◽

David R. Drover ◽

Lindsey Atkinson Ralls ◽

Edward T. Riley

Keyword(s):

Cesarean Delivery ◽

Low Dose ◽

Dose Range ◽

Morbidly Obese ◽

Obese Patients ◽

Hyperbaric Bupivacaine ◽

Block Height ◽

Elective Cesarean ◽

Double Blinded ◽

Nonobese Patients

Background It has been suggested that morbidly obese parturients may require less local anesthetic for spinal anesthesia. The aim of this study was to determine the effective dose (ED(50)/ED(95)) of intrathecal bupivacaine for cesarean delivery in morbidly obese patients. Methods Morbidly obese parturients (body mass index equal to or more than 40) undergoing elective cesarean delivery were enrolled in this double-blinded study. Forty-two patients were randomly assigned to receive intrathecal hyperbaric bupivacaine in doses of 5, 6, 7, 8, 9, 10, or 11 mg (n = 6 per group) coadministered with 200 μg morphine and 10 μg fentanyl. Success (induction) was defined as block height to pinprick equal to or more than T6 and success (operation) as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED(50)/ED(95) values were determined using a logistic regression model. Results ED(50) and ED(95) (with 95% confidence intervals) for success (operation) were 9.8 (8.6-11.0) and 15.0 (10.0-20.0), respectively, and were similar to corresponding values of a nonobese population determined previously using similar methodology. We were unable to measure ED(50)/ED(95) values for success (induction) because so few blocks failed initially, even at the low-dose range. There were no differences with regard to secondary outcomes (i.e., hypotension, vasopressor use, nausea, and vomiting). Conclusions Obese and nonobese patients undergoing cesarean delivery do not appear to respond differently to modest doses of intrathecal bupivacaine. This dose-response study suggests that doses of intrathecal bupivacaine less than 10 mg may not adequately ensure successful intraoperative anesthesia. Even when the initial block obtained with a low dose is satisfactory, it will not guarantee adequate anesthesia throughout surgery.

Download Full-text

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

American Journal of Critical Care ◽

10.4037/ajcc2016665 ◽

2016 ◽

Vol 25 (4) ◽

pp. 327-334 ◽

Cited By ~ 1

Author(s):

Felecia A. Lee ◽

Ashley M. Hervey ◽

Gina M. Berg ◽

David L. Acuna ◽

Paul B. Harrison

Keyword(s):

Intensive Care Unit ◽

Body Mass ◽

Injury Severity ◽

Outcome Variable ◽

Morbidly Obese ◽

Trauma Patients ◽

Resource Usage ◽

Hospital Resource ◽

Injury Characteristics ◽

Nonobese Patients

BackgroundAllocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients.ObjectivesTo determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable.MethodsA trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage.ResultsIn a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups.ConclusionsAssociations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/2016.4.jns152562 ◽

2017 ◽

Vol 127 (1) ◽

pp. 36-46 ◽

Cited By ~ 11

Author(s):

Hormuzdiyar H. Dasenbrock ◽

Michael O. Nguyen ◽

Kai U. Frerichs ◽

Donovan Guttieres ◽

William B. Gormley ◽

...

Keyword(s):

Morbid Obesity ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neurological Complications ◽

Infectious Complications ◽

Medical Complications ◽

Morbidly Obese ◽

Obese Patients ◽

Body Habitus ◽

Nonobese Patients ◽

Aneurysm Repair

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.

Download Full-text

A Comparison of McGrath MAC Versus C-MAC Videolaryngoscopes in Morbidly Obese Patients Undergoing Bariatric Surgery: A Randomized, Controlled Clinical Trial

Bariatric Surgical Practice and Patient Care ◽

10.1089/bari.2018.0052 ◽

2019 ◽

Vol 14 (1) ◽

pp. 25-33

Author(s):

Sedat Akbas ◽

Ahmet Selim Ozkan ◽

Erol Karaaslan

Keyword(s):

Bariatric Surgery ◽

Clinical Trial ◽

Controlled Clinical Trial ◽

Morbidly Obese ◽

Obese Patients ◽

Randomized Controlled Clinical Trial ◽

Randomized Controlled ◽

Mcgrath Mac

Download Full-text

Pharmacokinetics of Intravenous Linezolid in Moderately to Morbidly Obese Adults

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01453-12 ◽

2012 ◽

Vol 57 (3) ◽

pp. 1144-1149 ◽

Cited By ~ 40

Author(s):

Amira A. Bhalodi ◽

Pavlos K. Papasavas ◽

Darren S. Tishler ◽

David P. Nicolau ◽

Joseph L. Kuti

Keyword(s):

Body Weight ◽

Ideal Body Weight ◽

Total Body Weight ◽

Compartment Model ◽

Central Compartment ◽

Volume Of Distribution ◽

Lean Body Weight ◽

Morbidly Obese ◽

Total Body ◽

Nonobese Patients

ABSTRACTThe pharmacokinetics of linezolid was assessed in 20 adult volunteers with body mass indices (BMI) of 30 to 54.9 kg/m2receiving 5 intravenous doses of 600 mg every 12 h. Pharmacokinetic analyses were conducted using compartmental and noncompartmental methods. The mean (±standard deviation) age, height, and weight were 42.2 ± 12.2 years, 64.8 ± 3.5 in, and 109.5 ± 18.2 kg (range, 78.2 to 143.1 kg), respectively. Linezolid pharmacokinetics in this population were best described by a 2-compartment model with nonlinear clearance (original value, 7.6 ± 1.9 liters/h), which could be inhibited to 85.5% ± 12.2% of its original value depending on the concentration in an empirical inhibition compartment, the volume of the central compartment (24.4 ± 9.6 liters), and the intercompartment transfer constants (K12andK21) of 8.04 ± 6.22 and 7.99 ± 5.46 h−1, respectively. The areas under the curve for the 12-h dosing interval (AUCτ) were similar between moderately obese and morbidly obese groups: 130.3 ± 60.1 versus 109.2 ± 25.5 μg · h/ml (P= 0.32), and there was no significant relationship between the AUC or clearance and any body size descriptors. A significant positive relationship was observed for the total volume of distribution with total body weight (r2= 0.524), adjusted body weight (r2= 0.587), lean body weight (r2= 0.495), and ideal body weight (r2= 0.398), but not with BMI (r2= 0.171). Linezolid exposure in these obese participants was similar overall to that of nonobese patients, implying that dosage adjustments based on BMI alone are not required, and standard doses for patients with body weights up to approximately 150 kg should provide AUCτ values similar to those seen in nonobese participants.

Download Full-text