Prevalence Of Morbid Obesity Research Articles

Elevated CRP and IL6 Levels Predict Severe Cardiovascular Outcomes in COVID-19 Patients

This study explores the association between C-reactive protein (CRP) and interleukin 6 (IL-6) levels and cardiovascular complications in COVID-19 patients. Utilizing an ELISA kit for IL-6 and standard tests for CRP, we analyzed 192 samples, finding higher infection rates among the 50-69 age group, with significant prevalence of morbid obesity. Results showed a strong correlation between elevated CRP and IL-6 levels and the severity of cardiovascular complications, particularly in critical cases. These findings suggest that monitoring these biomarkers could be crucial for early intervention and managing cardiovascular risks in COVID-19 patients, potentially improving patient outcomes in clinical settings. Highlights: Biomarker Correlation: Elevated CRP and IL-6 levels are linked to severe cardiovascular complications in COVID-19 patients. Risk Management: Monitoring these biomarkers helps in early intervention and managing cardiovascular risks. Demographic Insights: The highest infection and complication rates are among the 50-69 age group with significant obesity. Keywords: COVID-19, Cardiovascular Complications, CRP, IL-6, Biomarker Monitoring

The Safety of Incisional Hernia Surgical Repair in Patients ≥70 Years.

Introduction Incisional hernias (IHs) are common complications of abdominal surgery. Frailty and advancing age could be related to poor outcomes after surgical interventions, especially after operating on challenging surgical fields with adhesions and dense scars. This study assesses the safety of IH surgical repair in patients aged 70 years and above. Methods A retrospective analysis of all patients who had IH surgical repair on an emergency and elective basis at a district hospital in the UK. The cohort was categorised into group I (<70 years) and group II (≥70years). A comparative analysis was conducted between these groups based on demographic data, comorbidities, hernia characteristics, operative data, and patient outcomes. Results This study encompassed 262 patients, with a mean age of 61.8 SD± 14.2 years, of whom 152 (58%) were females. Of these, group I comprised 173, and group II included 89 patients. Notably, group I exhibited a higher prevalence of morbid obesity, with 46 (28.8%) cases, as opposed to 12 (15.2%) in group II; p=0.021. Conversely, group II demonstrated a greater incidence of individuals with at least one comorbidity and chronic obstructive pulmonary disease (COPD) than group I, p=0.004 and 0.003, respectively. Fifty-five (32%) and 49 (29.3%) of group I had multiple defects and recurrent hernias compared to 24 (28.2%) and 16 (18.8%) in group II, p=0.541 and 0.071, respectively. The mean hospital stays were 5.5 ± 8.3 and 8.33 ± 18.7 days, and the mean durations of surgery were 131.6 ± 105.2 and 106.73 ± 74.22 minutes in groups I and II, p=0.057 and 0.181, respectively. No significant differences were observed in overall or wound-related complications,p=0.587 and 0.125. The rates of mortality within 30 days were three (1.7%) in group I and three (3.4%) in group II, with 90-day mortality rates at four (2.3%) and three (3.4%), respectively, indicating no significant difference. Similarly, no significant differences emerged between the groups regarding hernia recurrence rates (with a mean follow-up of 56 months) or 90-day readmission rates. Conclusions Surgical repair of IH is safe and effective in patients ≥70 years with comparable outcomes to younger patients.

The Dosage of Muscle Relaxants in Morbidly Obese Patients in Daily Practice - A Narrative Review.

The prevalence of morbid obesity in today's population around the world is alarming. Morbid obesity involves substantial changes in body composition and function, which can affect the pharmacodynamics and pharmacokinetics of many drugs. This paper aims to discuss the application of muscle relaxants and their reversing agents in patients with morbid obesity. This work is based both on the available literature and the author's personal experience. Dosage recommendations for muscle relaxants in morbidly obese patients are as follows: non-depolarizing relaxants like rocuronium, vecuronium, atracurium, and cisatracurium should be based on ideal body weight. Succinylcholine dosage should be adjusted to total body weight with a 200 mg maximum, while mivacurium should also be based on total body weight. Pancuronium is not used due to its long duration. Neostigmine dosing remains uncertain, but some suggest using total body weight. When it comes to Sugammadex opinions of the authors are divided, some indicate that it should be dosed based on ideal body weight, but more recent studies show that it should be based on 40% of corrected body weight.

Anesthesia for Morbidly Obese Patients.

The prevalence of morbid obesity (BMI >35 kg/m2) has risen steadily in recent decades. With the corresponding rise in the number of bariatric operations, anesthesiologists deal with this patient group more commonly than before, particularly in specialized centers. This review is based on publications retrieved by a selective search in PubMed, including current guidelines and recommendations issued by specialist societies, as well as expert opinion. In the anesthesiological care of morbidly obese patients, a preoperative assessment and risk stratification are just as important as the thoughtful selection of the anesthesia technique, the drugs used and their dosage, and perioperative management. A thorough understanding of the pathophysiological changes and comorbidities of morbid obesity and the associated risks is essential. The risk of pulmonary complications such as respiratory failure, hypoxia, and apnea is markedly higher in morbidly obese patients, especially those with obstructive sleep apnea. Short-acting, less lipophilic anesthetic drugs are particularly useful, as is multimodal pain therapy for the avoidance of high opiate doses. The indication for intensified postoperative monitoring depends on the patient's preexisting illnesses, the type of anesthesia, and the type of surgical procedure. Regional anesthetic techniques should be used if possible. The perioperative care of morbidly obese patients presents special challenges. The anesthesiologist must be aware of potential comorbidities, specific risks, and pathophysiological changes in order to provide adequate care to this patient group.

Differential Pattern of Obesity in Total Hip and Knee Arthroplasty Candidates

Purpose: This study examined the differential pattern of obesity between men and women with severe OA of the knee or hip joint. The relationship between creatinine, a pro-inflammatory parameter and obesity, sex, and site of joint involvement was examined. Design: This study involved a secondary analysis of prospectively collected data of patients who underwent hip or knee arthroplasty. Results: Data of 5,130 patients (1,989 males, 39%, 3,141 females, 62%), mean age: 66 (11) were used for data analysis. Of these patients, 2,038 patients underwent hip and 3,092 patients underwent knee arthroplasty. Prevalence of obesity (grade I and II) was higher in the TKA group as compared with THA group (55% vs. 38%) with the prevalence of morbid obesity (Grade II) being twice as many in the TKA group (27% vs. 14%), p &lt; 0.001. There was a statistically significant association between obesity and site of joint involvement ( p &lt; 0.001) and for the interaction between sex of the patient and site of arthritis ( p &lt; 0.001). In the TKA group, the sex factor was the only factor that was related to the pre-op creatinine level ( p &lt; 0.001). In THA group, both sex ( p &lt; 0.001) and obesity ( p = 0.002) showed an association with pre-op creatinine. Conclusion: This study provides further evidence that obesity has a multifaceted interaction with osteoarthritis with a differential pattern in hip and knee joints. Creatinine considered as a pro-inflammatory factor appears to have a differential role in hip and knee OA.

Total Hip and Knee Arthroplasty Surgery in the Morbidly Obese Patient: A Critical Analysis Review.

Obesity, defined as body mass index (BMI) ≥30, is a serious public health concern associated with an increased incidence of stroke, diabetes, mental illness, and cardiovascular disease resulting in numerous preventable deaths yearly. From 1999 through 2018, the age-adjusted prevalence of morbid obesity (BMI ≥40) in US adults aged 20 years and older has risen steadily from 4.7% to 9.2%, with other estimates showing that most of the patients undergoing hip and knee replacement by 2029 will be obese (BMI ≥30) or morbidly obese (BMI ≥40). In patients undergoing total joint arthroplasty (TJA), morbid obesity (BMI ≥40) is associated with an increased risk of perioperative complications, including prosthetic joint infection and mechanical failure necessitating aseptic revision. The current literature on the role that bariatric weight loss surgery before TJA has on improving surgical outcomes is split and referral to a bariatric surgeon should be a shared-decision between patient and surgeon on a case-by-case basis. Despite the increased risk profile of TJA in the morbidly obese cohort, these patients consistently show improvement in pain and physical function postoperatively that should be considered when deciding for or against surgery.

Internet-based assessment tools for predicting colorectal cancer risk: How do they communicate individualized risk to the young adult?

72 Background: Online prediction tools for cancer risk can inform individuals about their risk and potentially encourage adoption of risk-modifying health behavior. The Colorectal Cancer Risk Assessment Tool (CCRAT) is an interactive tool developed by the National Cancer Institute for estimating colorectal cancer (CRC) risk for individuals between the ages of 45 and 85 without high risk predisposing conditions. Given the rising incidence of CRC among young adults under age 50, we aimed to investigate the performance of CCRAT in estimating their CRC risk. Methods: An institutional protocol prospectively enrolled 563 patients newly diagnosed with non-hereditary CRC and administered a health behavior questionnaire at baseline. Self-reported demographics, diet and physical activity, medication use, and family history were extracted and entered into the CCRAT ( https://ccrisktool.cancer.gov/calculator.html ) to calculate their predicted 5-year and lifetime CRC risks. Health behaviors and the predicted CRC risks in reference to the population average were compared among three groups: youngest- (aged 18-44, N = 276, 49%), young- (aged 45-50, N = 178, 32%), and older-onset (aged &gt; 50, N = 109; 19%). Results: The patient groups did not significantly differ in gender or in family history of CRC, but the youngest group had significantly more non-White patients (27, 22, vs. 19%; p = 0.008) and distal tumors (80, 76 and 65%; p = 0.05). The youngest and young groups had a higher prevalence of morbid obesity (18 and 15% vs. 12%; p = 0.002) and active smokers (6 and 8% vs. 3%; p = 0.005). There were no significant differences in vegetable intake, moderate exercise, NSAID use, or female hormone use. The 5-year CRC risk was correctly predicted as “higher than average population” for a significantly smaller proportion of the youngest (42%) and young (45%) patients, when compared to their older counterpart (71%; p &lt; 0.001). Similarly, the tool communicated “higher than average” lifetime risk for CRC in only 56 and 60% of the youngest and young patients, but 72% of the older ones (p = 0.021). Conclusions: The existing risk prediction tool inadequately communicated CRC risk for adults younger than 50 years of age. Risk factors underlying young-onset CRC likely differ from and extend beyond those as currently assessed. New tools capturing age-specific risk factors are needed to accurately communicate individualized risk and potentially motivate risk-modifying lifestyles.

Morbid obesity impacts mortality among inpatients with type a aortic dissection: an analysis of the national inpatient sample

BackgroundStanford type A aortic dissection (T(A)AD) is one of the most dangerous cardiovascular diseases and morbid obesity is associated with the prognosis of many cardiovascular diseases. The aim of this study is to investigate the impact of morbid obesity on in-hospital mortality, total hospital costs and discover the prevalence of morbid obesity among inpatients with T(A)AD.MethodsPatients with a primary diagnosis of T(A)AD were identified from the National Inpatient Sample database (NIS) from 2008 to 2017. These patients were categorized into non-obesity, obesity and morbid obesity. Multivariable regression models were utilized to assess the association between obesity/morbid obesity and in-hospital mortality, total cost and other clinical factors. The temporal trend in prevalence of obesity/morbid obesity in T(A)ADs and the trend of in-hospital mortality among different weight categories were also explored.ResultsFrom the NIS database 8489 T(A)AD inpatients were identified, of which 7230 (85.2%) patients were non-obese, 822 (9.7%) were obese and 437 (5.1%) were morbid obese. Morbid obesity was associated with increased risk of in-hospital mortality (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.03–1.86), 8% higher total cost compared with the non-obese patients. From 2008 to 2017, the rate of obesity and morbid obesity in patients with T(A)AD have significantly increased from 7.36 to 11.33% (P < 0.001) and from 1.95 to 7.37% (P < 0.001). Factors associated with morbid obesity in T(A)ADs included age, female, elective admission, hospital region, dyslipidemia, smoking, rheumatoid arthritis/collagen vascular diseases, chronic pulmonary disease, diabetes and hypertension.ConclusionsMorbid obesity are connected with worse clinical outcomes and more health resource utilization in T(A)AD patients. Appropriate medical resource orientation and weight management education for T(A)AD patients may be necessary.

Marginal ulcers and associated risk factors after Roux-en-Y gastric bypass

As the prevalence of morbid obesity continues to climb in America, so does the popularity of the Roux-en-Y gastric bypass (RYGB) to achieve weight loss goals; however, a long-term risk of RYGB is marginal ulceration, which requires urgent surgery if perforated. We sought to identify characteristics associated with elective vs urgent presentation for marginal ulcer following RYGB. Retrospective data for consecutive cases with marginal ulcers that required surgical intervention from May 2016 to February 2021 were queried from our institution’s bariatric database, and differences in patient characteristics and clinical course were assessed according to presentation. Forty-three patients underwent surgery for marginal ulcer during the study timeframe. Twenty-four (56%) patients presented electively and were treated with resection of the gastroenterostomy and reanastomosis; the remaining 19 (44%) presented urgently with perforation and were treated with omental patch repair. Demographics, comorbidities, and medications were similar between groups. Patients with urgent presentations were less likely to have bleeds (0% vs. 33%, P = 0.0056) and strictures (16% vs. 46%, P = 0.0368), but were more likely to require admission to the intensive care unit (32% vs. 4%, P = 0.0325) and have a longer median length of stay (2 vs. 5 days, P < 0.0001). Bariatric surgeons must properly counsel patients about the risk of marginal ulcer development to prevent dangerous perforation, intensive care unit stays, and long hospitalizations.

313.1: Use of Transient Liver Elastography in the Evaluation of Liver Viability for Organ Donation and Transplantation

Introduction: The lack of enough livers for transplant worldwide is a reality and in México because of donation rates and high prevalence of morbid obesity this condition is worse. Strategies to determine whether a liver is suitable for donation depends on many occasions on the predonation estimation of fatty content. For March 2022, exist 244 patients in waiting list for liver transplant. In 2021 only 135 transplants were performed out of 293 brain death donors (none non heart beating donors). The reasons why 53.9% of the livers are not use are wide but one of them is because the higher prevalence of overweight and obesity in Mexican population, meaning a high number of steatosis of the liver. Since there is also a poor air connectivity among Mexican cities, the risk for primary organ failure is increased by longer ischemia time. Because the common study to evaluate liver steatosis is ultrasound despite the poor sensitivity, we proposed to use Transient elastography as a bedside tool to evaluate fat content or fibrosis of the liver condition before harvesting, minimizing the mobilization of complex and expensive logistics necessary to harvest a liver just to be discarded later and assuring better transplant results. Method: A prospective double-blind study was conducted in Hospital General del Estado from October 2015 to November 2021 that consist in that in every donor, no matter body mass index, a liver ultrasound was made by a radiologist and later a liver elastography was made on the same donor by another radiologist. Then the results were confronted during the organ harvesting by surgeon expertise who decided to take liver or not. Results: We had 32 brain death organ donors to whom an ultrasound and liver elastography was made. Median age was 41 years and weight were 74.66 kgs, with a range from 55 to 120 kgs. By using conventional ultrasound, out of the 32 donors, 93.8% were diagnosed without liver steatosis and 3.1% with mild and 3.1% with severe, while elastography showed 50% no steatosis, 15.6 light, 6.3 mild and 28.1 severe. Correlation of Transient elastography with surgical appearance was 100 % (No biopsy was taken to correlate this results with pathology).Conclusion: Our study showed that using ultrasound for evaluate liver steatosis for organ donation is not as good as it might be thought. For no liver steatosis concordance between ultrasound and elastography was 50% but in cases for severe infiltration, diagnosed rate was 1 Vs 9 for ultrasound vs elastography, and severe steatosis confirmed at the moment of surgery being evident the superiority of elastography for diagnosis of mild to severe steatosis and becoming a better resource in the evaluation of brain death organ donor.

Бариатрическая хирургия: описание клинического случая лапароскопической продольной резекции желудка у пациента с морбидным ожирением и гастроинтестинальной стромальной опухолью желудка

Gastrointestinal stromal tumor (GIST) is the most common tumor of the submucosal layer of the gastrointestinal tract. With the development of diagnostic methods, the incidence of GIST cases has increased significantly. Similarly, the prevalence of morbid obesity has increased significantly in the last decade. It is known from the literature that the incidence of GIST in obese patients is higher than in the general population. Although marginal and sparing resection is the first treatment for GIST, depending on the size and location of the tumor, broader surgery should also be considered. Laparoscopic sleeve gastrectomy is one of the most popular bariatric procedures. It can also be an option for concomitant treatment of both morbid obesity and gastric GIST when the tumor is within the range of sleeve resection.

Abstract 006: Neighbourhood Deprivation And Morbid Obesity: Insights From Houston Methodist Outpatient Learning Health System Registry

Introduction: Area Deprivation Index (ADI), a proxy measure for neighbourhood socioeconomic context, is informative for prioritizing limited resources in improving health outcomes. With emerging therapeutic options to improve cardiometabolic health among individuals with morbid obesity, whether available measures, such as ADI, for integrated health systems can identify this subpopulation at risk is unknown. Methods: This cross-sectional study analyzed data from 865,995 adult patients in the Houston Methodist Outpatient Learning Health System Registry between June 1 st , 2016 and July 20 th , 2021. Using University of Wisconsin-Madison School of Medicine’s ADI dataset, each patient was assigned an ADI rank according to the census block group of their geocoded residential address. BMI was calculated based on recorded height and weight. Patients with non-geocoded addresses (n=9 855), missing and abnormal BMI values (n=107 037) were excluded. Multinomial logistic regression models were used to examine the association between ADI and morbid obesity (BMI≥40 kg/m 2 ). Results: A total of 751,174 adults with an ADI ranking were included in the analysis. Overall, the prevalence of morbid obesity was 6.9% (n=51,609). The age-adjusted prevalence of morbid obesity increased across worsening neighborhood deprivation in overall population and across racial/ethnic subgroups (Figure 1). Each ADI rank increase in neighborhood disadvantage was associated with an unadjusted odds ratio (OR) of 1.022 (95% CI, 1.022-1.023) for morbid obesity compared to normal weight. After adjusting for age, sex and race/ethnicity, we found a statistically significant association of worst vs least level of neighborhood deprivation with patients with morbid obesity compared to normal weight (aOR, 3.75; 95% CI, 3.60-3.89). Conclusion: The study highlights utility of census-based measures to identify patients living in socioeconomically deprived areas for comprehensive morbid obesity management strategies.

Sex and Species Differences in the Development of Diet-Induced Obesity and Metabolic Disturbances in Rodents.

Prevalence and health consequences of obesity differ between men and women. Yet, most preclinical studies investigating the etiology of obesity have, to date, been conducted in male rodents. Notably, diet is a major determinant of obesity, but sex differences in rodent models of diet-induced obesity, and the mechanisms that underlie such differences, are still understudied. Here, we aim to determine whether time course and characteristics of diet-induced obesity differ between sexes in rats and mice, and to investigate the potential causes of the observed divergence. To achieve this, we offered the most commonly tested rodents of both sexes, SD rats and C57BL/6 mice, a free choice of 60 % high-fat diet (HFD) and regular chow; body weight, food intake, fat mass, brown adipose responses, locomotor activity and glucose tolerance were assessed in a similar manner in both species. Our results indicate that overall diet-induced hyperphagia is greater in males but that females display a higher preference for the HFD, irrespective of species. Female rats, compared to males, showed a delay in diet-induced weight gain and less metabolic complications. Although male rats increased brown adipose tissue thermogenesis in response to the HFD challenge, this was not sufficient to counteract increased adiposity. In contrast to rats, female and male mice presented with a dramatic adiposity and impaired glucose tolerance, and a decreased energy expenditure. Female mice showed a 5-fold increase in visceral fat, compared to 2-fold increase seen in male mice. Overall, we found that male and female rodents responded very differently to HFD challenge, and engaged different compensatory energy expenditure mechanisms. In addition, these sex differences are divergent in rats and mice. We conclude that SD rats have a better face validity for the lower prevalence of overweight in women, while C57BL/6 mice may better model the increased prevalence of morbid obesity in women.

Abstract 11718: Prevalence and Trends of Overweight and Obesity Among United States Veterans From 2002 to 2016

Objective: To present the age adjusted prevalence of obesity in men and women veterans by race and geographic region, and to examine the trends in body mass index over 14 years. Methods: We studied a random sample of one million adults from 2002 to 2016 who had height and weight measured at outpatient visits in the national Veterans Health Administration (VHA) electronic medical record system. We excluded those with prevalent cancer, gastric bypass procedures, and extremity amputations. We calculated the sex-specific and age adjusted prevalence of body mass index (obese &gt;30 kg/m 2 ) categories by self-reported race, and geographical region. Results: From a total of 791,392 men, and 50,928 women, average age was 68 years for men and 52 years for women in 2016. Mean BMI was 30 ± 6 kg/m 2 for men and 30 ± 7 kg/m 2 for women. In all, 13% (n=97,861) men and 25% (n=12,510) women were Black, 77% (n=573,232) men and 59% (n=29,538) women were White, 0.9% (n=6,479 ) men and 1.2% (n=613) women were Asian, 0.7% (n=5,202) men and 0.9% (n=473) women were Native Hawaiian/Pacific Islander, and 0.7% (n=4,490) men and 1% (n=510) women were American Indian. Over the 14-year period from 2002 to 2016, all racial groups were found to have a steady increase in prevalence of obesity except for Asians (Fig 1). Asian men and women had the lowest prevalence of obesity and morbid obesity (20% and 2% for men, 11% and 1% for women). Hawaiian or Pacific Islander and American Indian men and women had the highest increase in prevalence of morbid obesity comparing 2002 to 2016. Men and women in the Midwest had the highest prevalence of obesity and morbid obesity (32%, 6% for men and 31% and 8% for women). Women in the Northeast were found to have a decline in the prevalence of morbid obesity from 2002 to 2016. Conclusions: The prevalence of overweight and obesity has steadily increased in adult men and women veterans from 2002 to 2016 overall. However, there are differences across racial groups and geographic regions.

Thiamine deficiency after sleeve gastrectomy

The prevalence of morbid obesity has risen to global epidemic proportions. Bariatric surgery has been proven to be a safe and effective treatment for obesity with weight reduction, resolution of obesity-related co-morbidities, improved quality of life and an increased life expectancy. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. Obesity is associated with micronutrient deficiencies that results in the high prevalence of deficient vitamins status prior to bariatric surgery. After bariatric surgery, these micronutrient and vitamins deficiencies increase or occur de novo, and they may be threatening when left unattended. This presented clinical case demonstrates the clinical features of thiamine deficiency as well as the principles of laboratory and instrumental diagnostics. Electromyo­graphy is an informative method for diagnostic of muscle weakness. The lower serum thiamine level, neurological symptoms and electromyography results are the most important for the diagnosis of thiamine deficiency. Pathogenetic treatment can improve the patient’s condition in a short period of time. Although the SG is a purely restrictive procedure with no malabsorptive component, microelement or vitamin deficiency can occur in patients after procedure. The presented clinical case demonstrates the importance of timely thorough diagnosis and correct treatment of thiamine deficiency in patients after SG. Thus, patients after the LRS in deficiency of vitamin B1 may cause the development of neurological comp­lica­tions of varying severity, in particular dysmetabolic polyneuropathy. This condition is reversed and administration of an adequate and timely substitution therapy in patients with thiamine insufficiency allows be avoided the development of fatal complications.&#x0D;

Long-term outcomes of Roux-en-Y gastric bypass or sleeve gastrectomy in patients with cirrhosis; before, during or after liver transplantation: A single center's experience.

The increasing prevalence of morbid obesity (MO) results in parallel growth of obesity-associated liver diseases necessitating liver transplantation (LT). To examine the feasibility and safety of Roux-en-Y gastric bypass or sleeve gastrectomy in the setting of LT. This retrospective chart review included the data on all the MO candidates before and after LT who underwent bariatric surgery (BS) in our institution between 04/2013-09/2016. The reported outcomes were weight change and early and late postoperative complications (mean follow-up: 43±11.1months). Eighteen MO peri-LT patients (10 females, 8 males, average age 48years) were included in the study. Ten had cirrhosis (mean Model of End-stage Liver Disease [MELD] score of 12.5±6.42), three underwent concurrent LT and BS (mean MELD score 23.7±0.58), and five had LT (mean of 56months from LT). The mean percentage of total and excess weight loss was 31% and 81%, respectively. Six of the eight patients with type 2 diabetes mellitus became normoglycemic after BS. Three patients sustained perioperative complications. Two cirrhotic patients died 1 and 4.5years after BS with decompensation. Bariatric surgery appears to effectively address obesity in cirrhotic and LT patients. The surgical risk is higher than that of the regular BS population.

1225-P: Prevalence of Obesity and Bariatric Surgery Use in T1DM

With the increased prevalence of obesity, the phenotype of T1DM has changed. The prevalence of obesity in pts with T1DM is increasing, but there is limited data on how it compares to pts with T2DM. Bariatric surgery is effective for glycemic, weight and cardiometabolic risk surrogate amelioration in T2DM with obesity. However, the role of bariatric surgery in T1DM with obesity is largely unexplored. Retrospective chart review was done of patients with T1DM seen in Ochsner clinic system from January 2015 to January 2018. Obesity prevalence was quantified. Pts with bariatric surgery (BS) history were identified and their cardiometabolic surrogates pre and post BS were obtained. This was compared to pts with T2DM over the same time period. More in depth chart analysis of 300 pts from this cohort of T1DM pts was done to better characterize features of these pts 10, 282 pts with T1DM were identified over the observation period vs. 146,617 pts with T2DM. The prevalence of obesity in the T1DM cohort was 48.3% vs. 59.7% in the T2DM cohort while the prevalence of morbid obesity was 14.5% vs. 19% in the T1DM vs. T2DM groups. The number of pts who had bariatric surgery was 25 vs. 307 in the T1DM vs. T2DM groups. The percentage utilization of bariatric surgery as an intervention for obesity was very low in both cohorts (0.5 vs. 0.35 % in the T1DM vs. T2DM groups). Of the 300 pts with detailed chart review, actual diabetes subtypes were 163 (54%) T1DM, 43 (14.3%) as LADA, 1 (0.3%) as maturity-onset diabetes of the young, 2 (0.7%) as type 1.5 (essentially LADA), 8 (2.7%) as type 1+2 (T1DM with obesity and insulin resistance), 11 (3.7%) deceased, 71 (23.7%) as T2DM that had been miscoded as T1DM. For subsequent analyses, T1DM, LADA, type 1.5, and type 1+2 were included in the T1DM cohort. The weight and cardiometabolic surrogate changes in T1DM subjects were inconsistent and less marked than in T2DM subjects. Obesity prevalence in T1DM is close to that in T2DM and the use of bariatric surgery as an intervention remains very low both in T1DM and T2DM pts with obesity. Disclosure W. A. West: None. K. G. Romo: None. G. I. Uwaifo: None.

Are surgeons still performing primary total knee arthroplasty in the morbidly obese?

The purpose of this study was to assess total knee arthroplasty (TKA) volume and rates of early complications in morbidly obese patients over the last decade, where the introduction of quality models influencing perioperative care pathways occurred. Patients undergoing TKA between 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI < 40 kg/m2 and ≥ 40 kg/m2 and evaluated by the number of cases per year. The 30-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between groups using odds ratios (ORs) and multivariate analyses. In total, 314,695 patients underwent TKA and 46,362 (15%) had BMI ≥ 40 kg/m2. The prevalence of morbid obesity among TKA patients did not change greatly, ranging between 14% and 16%. Reoperation rate decreased from 1.16% to 0.96% (odds ratio (OR) 0.81 (95% confidence interval (CI) 0.66 to 0.99)) for patients with BMI < 40 kg/m2, as did rates of readmission (4.46% to 2.87%; OR 0.61 (0.55 to 0.69)). Patients with BMI ≥ 40 kg/m2 also had fewer readmissions over the study period (4.87% to 3.34%; OR 0.64 (0.49 to 0.83)); however, the rate of reoperation did not change (1.37% to 1.41%; OR 0.99 (0.62 to 1.56)). Significant improvements were not observed for infective complications over time for either group; patients with BMI ≥ 40 kg/m2 had increased risk of both deep infection and wound complications compared to non-morbidly obese patients. Rate of any complication decreased for all patients. The proportion of TKAs in morbidly obese patients has not significantly changed over the past decade. Although readmission rates improved for all patients, reductions in reoperation in non-morbidly obese patients were not experienced by the morbidly obese, resulting in a widening of the complication gap between these cohorts. Care improvements have not lowered the differential risk of infective complications in the morbidly obese. Cite this article: Bone Joint J2021;103-B(6 Supple A):38-44.

Effects of intragastric balloon on obesity in obese Korean women for 6 months post removal.

BACKGROUND/OBJECTIVESThe prevalence of morbid obesity in Korean women has consistently been increasing, while the overall prevalence rate of obesity in Korean women seems to be stable. In addition to bariatric surgery, intragastric balloons (IGBs), as a nonsurgical therapy, have been reported to be effective in weight loss. However, the beneficial effects of IGB in Korean women with obesity have not been fully investigated. The aim of this study was to evaluate the changes in fat mass in Korean women with obesity who had undergone IGB treatment for 6 mon.SUBJECTS/METHODSSeventy-four women with obesity (body mass index [BMI] ≥ 25.0 kg/m2) were recruited. Clinical data, including general information, comorbidities with obesity, anthropometric data, and changes in the body fat composition before and after IGB treatment, were obtained from the subjects.RESULTSMost subjects had one or more comorbidities, such as osteoarthropathy and woman's disease, and had poor eating behaviors, including irregular mealtimes, eating quickly, and frequent overeating. Body composition measurements showed that weight, fat mass, and waist-hip circumference ratio decreased significantly at 6 mon after IGB treatment. In particular, women with morbid obesity (BMI ≥ 30 kg/m2) showed 33% excess weight loss. There was no significant difference in skeletal muscle mass and mineral contents after IGB treatment.CONCLUSIONSThis study suggested that 6 mon of IGB treatment can be a beneficial treatment for obesity without muscle mass and bone mineral loss.

Endoscopic Double-Pigtail Catheter (EDPC) Internal Drainage as First-Line Treatment of Gastric Leak: A Case Series during Laparoscopic Sleeve Gastrectomy Learning Curve for Morbid Obesity.

Objectives The prevalence of morbid obesity has dramatically increased over the last several decades worldwide, currently reaching epidemic proportions. Gastric leak (GL) remains the potentially fatal main complication after sleeve gastrectomy (SG) for morbid obesity. To our knowledge, there are no standardized guidelines for GL treatment after laparoscopic sleeve gastrectomy (LSG) yet. The aim of this study was to represent our institutional preliminary experience using the endoscopic double-pigtail catheter (EDPC) as the method of internal drainage and propose it as first-line treatment in case of GL after LSG. Methods One hundred and seventeen patients were admitted to our surgical department and underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity from March 2014 to June 2019. In 5 patients (4.3%) of our series, GL occurred as a complication of LSG. EPDC was the stand-alone procedure of internal drainage and GL first-line treatment. The internal pig tail was endoscopically removed from 30th to 40th POD in all cases. Results Present data (clinical, biochemical, and instrumental tests) showed a complete resolution of GL, with promotion of a pseudodiverticula and complete re-epithelialization of leak. Follow-up was more strict than usual (clinical visit and biochemical test on 7th, 14th, and 21st day after discharge; a CT scan with gastrografin on 30th day from discharge if clinical visit and exams were normal). Conclusion This was a preliminary retrospective observational study, conducted on 5 patients affected by GL as a complication of LSG for morbid obesity. EDPC maintains the safety, efficacy, and nonexpensive characteristic and may be proposed as better first-line treatment in case of GL after bariatric surgery.