Early Convalescence Research Articles

The Combination of Laparoscopy and Nephroscopy for Treatment of Stones in Pelvic Ectopic Kidneys

Introduction: Minimally invasive treatment modalities for patients with large stone burden within pelvic kidneys present a special challenge. Interposing bowel loops between the kidney and the anterior abdominal wall, abnormalities in the vascular supply, and mal-rotation of the caliceal system are reasons of difficulties in percutaneous nephrolithotomy (PNL). Minimally invasive treatment modalities of large stones in ectopic pelvic kidneys have included pure laparoscopic pyelolithotomy,1–3 laparoscopy-assisted PNL,4–7 and ultrasound-guided PNL.8 These are attractive treatment options because they have the advantages of reduced analgesic requirement, shorter hospital stay, early convalescence, and better cosmoses in addition to high safety and efficacy profiles. The combination of laparoscopic and percutaneous approaches allows the establishment of the percutaneous tract into the kidney under direct vision, thus avoiding the risk of injury to abdominal viscera and blood vessels. This video presents the technique of the combination of laparoscopy and nephroscopy for treatment of stones in pelvic ectopic kidneys. Patients and Methods: The study included seven men and four women (mean age, 43 ± 9 years). Laparoscopy-assisted PNL was performed for caliceal stones in five patients after failure of shockwave lithotripsy. Laparoscopic pyelolithotomy was performed for six patients with large or branched renal pelvic stones. The patient was placed in the Trendelenburg position with slight lateral elevation of the side to be operated. In laparoscopy-assisted PNL the primary surgeon stands on the same side of the affected kidney and the assistant on the opposite side, whereas in laparoscopic pyelolithotomy the surgeon stands on the opposite side of the affected kidney. Three or four transperitoneal ports were placed in a fan-shaped distribution. The stone or the renal pelvis was identified using intraoperative fluoroscopy. Intermittent fluoroscopy was used to identify the point of entry to the desired calix during dilatation and during fixation of the nephrostomy tube. Results: The average preoperative stone length was 3 ± 1 cm (range, 1.1–4.2). There were some adhesions between the intestinal loops and the peritoneum on the anterior surface of the kidney in three patients (27%). There were neither intraoperative nor postoperative complications, and conversion to open surgery was not required. The mean hospital stay was 3.5 ± 0.7 days (range, 2–4). The stone-free rate was 91% as all stones were removed completely in 10 patients, whereas 1 patient had residual caliceal fragment that was treated with shockwave lithotripsy. After a mean follow-up of 27 ± 6 months, two out of the five patients who underwent laparoscopy-assisted PNL showed stone recurrence and were treated with extracorporeal shockwave lithotripsy. Conclusion: The combination of laparoscopy and nephroscopy for treatment of stones in pelvic kidneys is feasible, safe, and effective. The authors has nothing to disclose. Runtime of video: 8 min 24 sec

Serological Profiling of a Candida albicans Protein Microarray Reveals Permanent Host-Pathogen Interplay and Stage-Specific Responses during Candidemia

Candida albicans in the immunocompetent host is a benign member of the human microbiota. Though, when host physiology is disrupted, this commensal-host interaction can degenerate and lead to an opportunistic infection. Relatively little is known regarding the dynamics of C. albicans colonization and pathogenesis. We developed a C. albicans cell surface protein microarray to profile the immunoglobulin G response during commensal colonization and candidemia. The antibody response from the sera of patients with candidemia and our negative control groups indicate that the immunocompetent host exists in permanent host-pathogen interplay with commensal C. albicans. This report also identifies cell surface antigens that are specific to different phases (i.e. acute, early and mid convalescence) of candidemia. We identified a set of thirteen cell surface antigens capable of distinguishing acute candidemia from healthy individuals and uninfected hospital patients with commensal colonization. Interestingly, a large proportion of these cell surface antigens are involved in either oxidative stress or drug resistance. In addition, we identified 33 antigenic proteins that are enriched in convalescent sera of the candidemia patients. Intriguingly, we found within this subset an increase in antigens associated with heme-associated iron acquisition. These findings have important implications for the mechanisms of C. albicans colonization as well as the development of systemic infection.

Differential expression of enteric neuroimmune‐network in invasive and acute watery diarrhoea

We aimed to evaluate the changes of nerve morphology and distribution of neurotransmitters and neuropeptides in the rectum of Shigella flexneri-infected patients and in the duodenum of Vibrio cholerae O1-infected patients. Nerve morphology was observed by transmission electron microscopy. Immunoreactivity of nerve growth factor (NGF), neurotransmitters and neuropeptides in tissues were studied by immunohistochemistry. Ultrastructural analysis of intestinal biopsy revealed persisting axons degeneration throughout the study period in all patients. Regeneration was already evident at the acute stage with marked increase at late convalescence. Both acute shigellosis and cholera were accompanied by increased expression of NGF and histamine and decreased expression of serotonin that was restored at convalescence. Immunoreactivity of vasoactive intestinal peptide (VIP) was increased during acute cholera, whereas in shigellosis VIP- and substance P-immunoreactive nerves appeared at early convalescence. Both shigellosis and cholera induced long-lasting degeneration of enteric neuronal axons, despite the presence of ongoing proliferation and regeneration processes. Neurotransmitters and neuropeptides may play differential roles in invasive and watery diarrhoea.

Fast-track-Kinderchirurgie

Fast-track surgery is a comprehensive perioperative treatment concept that has been successfully performed and widely accepted in adult surgery since the 1990s. The crucial aim is to speed up convalescence and to avoid perioperative complications as pneumonia and thrombosis. Compared to conventional treatment strategies, hospital stays are substantially reduced. In the paediatric field fast-track surgery is not generally established. However, in recent studies a high efficiency of paediatric surgical fast-track procedures with respect to medical, psychological, economical and ethical parameters has been shown. It has been confirmed that early convalescence leads to an increase of satisfaction of the patients and their parents without higher complication rates. Shorter hospital stays lead to reduced expenses for the health insurances and parents. Fast-track concepts are not implemented in the German reimbursement system G-DRG. Thus, problems with intensified nursing and reimbursement remain to be solved.

Intake of Lipid-based Nutrient Supplements during Illness and Convalescence among Moderately-underweight Malawian Childrenhomes

Intake of Lipid-based Nutrient Supplements during Illness and Convalescence among Moderately-underweight Malawian Childrenhomes

New dengue antibody assay with unique differential detection of IgG and IgM antibodies

Objectives Most of the serological methods, traditional and recent, that have been developed to assess laboratory confirmation of dengue infection, suffer from the need to use separate tests for IgM and for IgG and the need for paired serum specimens in order to establish a clinical interpretation. Moreover, most of the IgG tests ignore early convalescence as well as past exposure. The objectives of this study is to demonstrate the advantages of the ImmunoComb Dengue BiSpot, a new dengue antibody assay, that detects simultaneously both dengue-specific IgM and IgG, in determining type and status of infection in a single test. Designs and methods Single and paired positive and negative specimens obtained from various dengue-high prevalent regions and from dengue-free areas were used. The specimens were comprised of admission samples of suspected patients and secondary dengue infection individuals, a group of hospital patients, asymptomatic to dengue who originated from dengue high prevalence areas and dengue-negative volunteers. All samples were tested by the ImmunoComb Dengue BiSpot kit along with the gold standard assays of Hemagglutination-inhibition (HAI) and MAC ELISA. Results Testing 365 gold standard positive specimens from different regions, the ImmunoComb Dengue BiSpot kit revealed sensitivity for IgM of 97.5% and 99.1% for IgG. The IgG was segregated into 2 groups: 86.6% for high titer and 12.5% for low titer of IgG. The overall sensitivity was 98.9%. The overall specificity of the kit, testing 657 samples, mostly from dengue-free area was 97.9%. The higher diagnostic resolution of the Dengue BiSpot test was demonstrated when the performance of the kit on the various groups was compared to the gold standard tests and the dengue status was determined in paired specimens by the new assay. Conclusions The results of the present studies demonstrate the advantages of ImmunoComb Dengue BiSpot assay as an alternate strategy for the determination of dengue infection status. The combined use of IgM and IgG to discriminate between primary and secondary infections, on one hand, and providing high resolution in distinction of convalescence stage and past infection, on the other hand, endow the kit with improved capacity in assessing the clinical status of a tested individual in a single test.

Laparoscopic Rectosigmoid Resection for Acute Sigmoid Diverticulitis

Laparoscopic sigmoid colectomy has been widely accepted as elective approach but is, however, still discussed controversially for acute cases. Patients receiving a laparoscopic early single-stage procedure benefit from an early postoperative convalescence with a minimum of disability. As more surgeons gain expertise in minimally invasive surgery of the rectosigmoid, this video highlights the main steps of a rectosigmoid resection for acute complicated diverticulitis.

Dengue in Vietnamese Infants—Results of Infection‐Enhancement Assays Correlate with Age‐Related Disease Epidemiology, and Cellular Immune Responses Correlate with Disease Severity

The pathogenesis of severe dengue is not well understood. Maternally derived subneutralizing levels of dengue virus-reactive IgG are postulated to be a critical risk factor for severe dengue during infancy. In this study, we found that, in healthy Vietnamese infants, there was a strong temporal association between the Fc-dependent, dengue virus infection-enhancing activity of neat plasma and the age-related epidemiology of severe dengue. We then postulated that disease severity in infants with primary infections would be associated with a robust immune response, possibly as a consequence of higher viral burdens in vivo. Accordingly, in infants hospitalized with acute dengue, the activation phenotype of peripheral-blood NK cells and CD8+ and CD4+ T cells correlated with overall disease severity, but HLA-A*1101-restricted NS3(133-142)-specific CD8+ T cells were not measurable until early convalescence. Plasma levels of cytokines/chemokines were generally higher in infants with dengue shock syndrome. Collectively, these data support a model of dengue pathogenesis in infants whereby antibody-dependent enhancement of infection explains the age-related case epidemiology and could account for antigen-driven immune activation and its association with disease severity. These results also highlight potential risks in the use of live attenuated dengue vaccines in infants in countries where dengue is endemic.

The role of cardiac rehabilitation in influencing psychological outcomes

AbstractAnxiety and depression are common after acute cardiac events. They can have a major adverse impact upon outcomes, although past studies report conflicting results regarding the relationships between anxiety, depression and outcomes such as mortality. Depression has been shown to be associated with non‐adherence of patients. Cardiac rehabilitation programmes conducted during early convalescence provide a valuable opportunity to identify and support patients who experience anxiety and depression, and encourage adherence to advice. Clinical data support the positive effects upon patients' psychological outcomes of cardiac rehabilitation programmes offering group exercise, education and behavioural interventions. However, more rigorous research is required to confirm such benefits. Systematic screening of patients should be undertaken on entry to cardiac rehabilitation to identify high‐risk patients and to assist them. Copyright © 2008 John Wiley & Sons, Ltd.

Intervention of early convalescence nursing of patients with poststroke depression

Objective To discuss the influence of the nursing intervention of early, onvalescence on the depressed feelings and activity of daily living of patients with post - stroke epression (PSD) . Methods 76 patients with PSD were equally and randomly divided into a control group and a nursing intervention group. The former group were treated by anti - depression ledicine, while the following group were intervened by nursing of early convalescence on the asis of being applied anti - depression medicines. They were evaluated both before and aftertreatment by Hamilton Depression Rating Scale for Depression (HAMD) and Barthel Index (BI) . Results After treatment, HAMD d the nursing intervention group was obvioualy lower than those of the control group (P <0. 01 ), while the nursing intervention group's BI was apparently higher than the control gronp's (P < 0. 01 ) Conclusion Patients with PSD are treated with medicines and meanwhile are intervened by nursing of early convalescence ease depression emotion, mprove activity of daily living and facilitate convalescence of body functio. Key words: Stroke; Depression; Nursing intervention; Convalescence

Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults

Inflammation influences the assessment of nutritional status. For example, inflammation reduces plasma retinol concentrations and vitamin A deficiency is overestimated. Conversely inflammation increases plasma ferritin concentrations and Fe deficiency is underestimated. Blood samples were obtained from 163 free-living HIV-1-infected adults, not on continuous medication, anti-retroviral drugs or micronutrients, not unwell and who had not reached WHO stage IV of HIV/AIDS. We used four markers of inflammation, C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), alpha1-antichymotrypsin and erythrocyte sedimentation rate but mainly CRP and AGP were used to separate the subjects into four groups: 'healthy' where both CRP and AGP were normal; 'incubation phase' where CRP was elevated; 'early convalescence' where AGP and CRP were elevated and 'late convalescence' where only AGP was elevated. Correction factors were calculated to remove the influence of inflammation from each biomarker and group where inflammation was present and the data are shown before and after recalculation. The correction increased median plasma retinol concentrations of the whole group from 1.16 to 1.33 micromol/l, comparable with values (mean 1.29 micromol/l) in HIV-negative Kenyan women. Median ferritin concentrations fell by about 50% in both sexes and the number of women with plasma ferritin concentrations < or = 12 microg/l increased from eleven to twenty. The correction also increased plasma carotenoids and Hb but not alpha-tocopherol concentrations. We suggest that the method described to remove the influence of inflammation from nutritional biomarkers should be generally applicable in apparently healthy people and prevents discarding valuable data because of mild inflammation. The method does now need to be tested in other populations.

Comparison of Postoperative Pain, Convalescence, and Patient Satisfaction after Laparoscopic and Percutaneous Ablation of Small Renal Masses

To compare the convalescence and patient satisfaction between laparoscopic and percutaneous ablation for management of small renal masses. We performed a telephone survey comparing convalescence and operative satisfaction of patients who underwent laparoscopic and percutaneous ablation between October 2000 and June 2006 at our institution. A retrospective chart review was performed to compare perioperative and postoperative convalescence parameters. A total of 93 patients underwent ablation of 103 small renal masses at our institution. Laparoscopic cryoablation was performed in 58 patients, percutaneous cryoablation in 20, and percutaneous radiofrequency ablation in 15 patients. Mean patient age was 66 years (range 24-86 years), median ASA (American society of Anesthesiologists) score was 3, and mean body mass index (BMI) was 30 kg/mm(2). There was no significant difference in the mean age, BMI, and median ASA scores between the groups. The mean diameter of the treated mass was slightly larger in the laparoscopic ablation group (2.6 cm) compared with masses in the percutaneous cryoablation (2.2 cm, P=0.027) and percutaneous radiofrequency ablation (2.2 cm, P=0.042) groups. All procedures were performed under general anesthesia. Compared with laparoscopic cryoablation, percutaneous cryoablation was associated with fewer probes used per lesion (P<0.04), shorter mean anesthesia time (P=0.001), shorter mean hospital stay (P=0.007), early return to nonstrenuous activity (P=0.007), and shorter time to complete recovery (P = 0.05). Similarly, compared with laparoscopic cryoablation, percutaneous radiofrequency ablation was associated shorter mean anesthesia time (P<0.001), early return to nonstrenuous activity (P=0.009), early return to strenuous activity (P=0.007), early return to strenuous activity (P=0.04), and early return to work (P=0.05). There was no difference in the percent of patients who had a preablation biopsy, the median opioid analgesic requirement, and patient satisfaction measured on a 0 to 5 scale between various groups. Our study suggests that percutaneous ablation in carefully selected patients is associated with early convalescence compared with laparoscopic ablation.

Living alone predicts 30-day hospital readmission after coronary artery bypass graft surgery

Earlier studies show that medical factors and disease severity predict early readmission to hospital after coronary artery bypass graft surgery (CABGS). Few studies have investigated psychosocial predictors. This study investigated medical, sociodemographic and psychosocial predictors of 30-day hospital readmission. A consecutive sample of 181 patients wait-listed for CABGS completed self-report questionnaires before surgery, and at 2 and 6 months after surgery. Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t=2.12, df=179, P=0.035), and more likely to be unmarried (chi=5.80, df=1, P=0.016), live alone (chi=8.33, df=1, P=0.004), have a history of hypertension (chi=2.731, df=1, P=0.098) and have higher anxiety before surgery (t=1.67, df=175, P=0.097). When these variables were entered into a backward stepwise logistic regression, the only significant unique predictor of 30-day readmission was living alone (Wald=7.08, odds ratio=3.42, P=0.008). Patients living alone were over three times more likely than those living with others to be readmitted to hospital. Disease severity and other medical factors were not associated with readmission. Living alone was identified as the single most important risk factor for early readmission after CABGS. Patients who live alone may benefit from additional support during early convalescence. Intervention studies could explore support options for these patients.

The Influence and Benefits of Controlling for Inflammation on Plasma Ferritin and Hemoglobin Responses following a Multi-Micronutrient Supplement in Apparently Healthy, HIV+ Kenyan Adults

Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and α1-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin) increased in both men (48 μg/L; P = 0.02) and women (12 μg/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation.

Chinese couples’ experiences during convalescence from a first heart attack: a focus group study

This paper is a report of a study to explore Chinese patients' and partners' experiences during early convalescence from a first heart attack. There are important socio-cultural differences between Chinese and western populations and comparatively little is known about the experiences of Chinese patients and partners living with a first heart attack. A qualitative study using focus groups was conducted in 2005 with 17 Chinese patients and their partners during convalescence from a first heart attack. The interviews were tape-recorded and transcribed. Analysis was used to identify categories using established qualitative phenomenological techniques. Content analysis of the data revealed five major categories: enduring uncertainty; coping with changes; experiencing emotional reactions; living with medications and needing professional help. The experiences of Chinese patients and partners during early convalescence from a first heart attack are different from their western counterparts and are affected by cultural traditions. Findings from this study may provide useful pointers for health professionals to deliver culturally sensitive and appropriate support and education during early convalescence.

Pretransplant laparoscopic nephrectomy in adult polycystic kidney disease: a single centre experience

To report our experience with pretransplant laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD), as ADPKD often progresses to end-stage renal disease and most azotaemic patients with ADPKD have enlarged kidneys, making graft placement difficult. We retrospectively reviewed the medical records of 13 patients with renal failure attributable to ADPKD who underwent pretransplant laparoscopic nephrectomy (21 renal units) from August 2002 to December 2006. Five patients had a unilateral nephrectomy, seven had a staged bilateral nephrectomy, and one had a simultaneous bilateral nephrectomy. All patients underwent subsequent living-related renal transplantation. The operative duration, haemoglobin decrease, blood transfusion, hospital stay, analgesic requirement and time to receipt of a transplant were compared with those of patients who underwent open pretransplant nephrectomy (14 patients) from 1984 to 2001. Kidneys of a size to interfere with graft placement were the commonest indication for surgery (eight patients). In comparison with open surgery, the mean (SD) hospital stay at 9.26 (2.9) vs 4.86 (0.9) days, analgesic requirement at 320 (120) vs 221 (120.5) mg of tramadol, blood transfusion rate at 1.3 (0.5) vs 0.9 (0.6) units, period to receive a graft kidney at 29.77 (4.6) vs 9.14 (3.38) days, were significantly less with laparoscopy. The complications noted were single instances of splenic capsular tear, pleural tear, sub-acute intestinal obstruction and vena caval injury. Pretransplant laparoscopic nephrectomy in patients with ADPKD has all the benefits of minimally invasive surgery such as reduced intraoperative blood loss and minimal postoperative pain leading to early and faster convalescence. These benefits help in decreasing the period between nephrectomy and transplantation. The surgeon needs to have considerable experience in laparoscopy before embarking on laparoscopic pretransplant nephrectomy.

The legacy of a critical illness

Improved management of the acute phase of a critical illness ensures that approximately two in three patients will eventually leave hospital, yet survival does not necessarily mean a return to full health. The more widespread use of follow-up clinics in patients discharged from an intensive care unit (ICU) has shown a substantial legacy in terms of physical, cognitive and psychological dysfunction. Problems are all too common during early convalescence from a life-threatening illness, and recovery can be slow and incomplete thereafter. The recognition and management of persisting disability among ICU survivors formed the subject of a meeting held at the Royal Society of Medicine in November 2006, and these topics are covered in the six articles that follow this editorial.

Reactivation of Graves’ Orbitopathy after Rehabilitative Orbital Decompression

To present and discuss three cases of apparent reactivation of Graves' orbitopathy (GO) after orbital decompression and to evaluate the incidence of this phenomenon. Observational case series and retrospective follow-up study. A few weeks after surgery 2 patients with GO (patients 1 and 2), treated at our institution with rehabilitative bony orbital decompression during the static phase of the disease showed clinical and radiologic evidence of reactivated orbitopathy. After this observation, a sample of 249 patients who had consecutively undergone the same treatment for the same reason before the second of the 2 observed patients was selected for this study. The records of the selected patients were retrospectively reviewed searching for cases presenting with clinical and radiologic evidence of GO reactivated as a consequence of any type of bony orbital decompression. Patients treated with perioperative systemic glucocorticoids or who had concurrent periorbital diseases, injuries, or surgeries, or who had immunocompromised conditions or a follow-up of < or =2 months, were excluded. Incidence of reactivation. Clinical history, clinical and radiologic characteristics, treatment modalities, and time course of the reactivation in patients presenting with this phenomenon. Decompression surgery took place between 1994 and 2000. Eleven patients were excluded for having been treated with perioperative glucocorticoids. Only 1 patient (patient 3) presented with reactivation. The incidence of the phenomenon that we regard as reactivation of GO after rehabilitative bony orbital decompression was therefore 1.3% (3/239). In all 3 patients, the reactivation took place a few weeks after surgery, after an early normal convalescence period and could be controlled with systemic immunosuppression or orbital radiotherapy. None of the patients we report developed further episodes of reactivation during the follow-up period (mean, 7.5 years). Based on its clinical characteristics, we suggest naming our observation delayed decompression-related reactivation and we propose using its acronym DDRR when referring to it. Although DDRR appears to be a rare event, it is important for physicians and patients to be aware of its possible occurrence with rehabilitative decompression surgery.

Trajectories of recovery of quality of life in women after an acute cardiac event

Female cardiac patients' health-related quality of life (HRQoL) during the first year after an acute cardiac event was compared with age-weighted Australian population norms. The impact of age, event type and cardiac rehabilitation (CR) programme attendance on recovery was assessed. The short form 36-item health survey (SF-36) was administered to 229 women aged from 36 to 84 years consecutively admitted to 4 hospitals after acute myocardial infarction (AMI) or to undergo coronary artery bypass graft surgery (CABGS). Data were collected at 4 time points over 12 months. SF-36 subscale scores were compared with age-weighted norms for Australian women. Mplus was used to analyse growth trajectories for SF-36 subscales. Patients had impaired HRQoL at baseline (except in general health), with progressive improvement over time. Recovery to normative levels was fastest in the areas of bodily pain and mental health (by 2 months) and slowest in the area of physical functioning, and physical and emotional role limitations (by 12 months). By 4 months, general health scores had surpassed population norms. For all scales, most improvement occurred in the first 2 months, with little subsequent improvement. CABGS patients showed significantly more improvement than AMI patients in several areas, partly due to the poorer functioning of CABGS patients at baseline. Rate of improvement was not influenced by patients' age or frequency of CR attendance. Impairment of HRQoL in female cardiac patients is most pronounced at the time of the event, with most recovery occurring during early convalescence and full recovery in all domains by 12 months post-event.

Time-Course Increases in Cardiorespiratory Fitness after Bariatric Surgery

BACKGROUND: The rise in morbid obesity has led to advancements in clinical treatment modalities. Of these, bariatric surgery (BS) has been shown to elicit significant weight loss in the morbidly obese. Few data, however, are available regarding the effect of BS on cardiorespiratory (CR) fitness parameters in this escalating patient subset. PURPOSE: To determine the effect of BS on CR fitness, we evaluated CR fitness following BS in a morbidly obese population. METHODS: Fourteen patients (12 women, 2 men; mean + SD age = 46 + 11 years) who underwent Roux-en-Y gastric bypass surgery were studied. As part of their pre- and post-surgical screening, maximal graded exercise testing with concomitant oxygen consumption (VO2) measurement was conducted. Pre- and post-BS tests were compared to determine changes in CR fitness. RESULTS: Select demographic and CR variables pre- and post-surgery are shown in the Table. Significant decreases in body weight and BMI and increases in treadmill time and maximal VO, expressed as mL/kg/min or metabolic equivalents (METs), were noted following BS [mean follow-up time = 139 days (range = 32–396 days)]. The CR benefits of BS appeared to be time-dependent; patients having follow-up testing > 100 days (mean ± SD = 221 ± 109.4) post-surgery demonstrated significantly greater decreases in body weight and increases in CR fitness as compared with those who had earlier (mean ± SD = 57 ± 16.9 days) follow-up.Table: Changes in body composition and cardiorespiratory variables following bariatric surgeryCONCLUSION: Bariatric surgery results in a marked weight loss and increased CR fitness, as determined by direct measurement of VO2 max. These improvements appear to be time-dependent; thus, exercise testing should be conducted after adequate recovery from BS (>100 days) to achieve optimal CR results. Testing too soon after BS (i.e., during early convalescence) may camouflage potential improvements in functional capacity.