Normal Body Mass Index Patients Research Articles

Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis

BackgroundTo conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of normal and high body mass index (BMI) to provide the predictive diagnosis for clinic. MethodsLiterature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to February.RCTs comparing the benefits and risks of normal BMI with those of high BMI in primary total knee arthroplasty (TKA) were included. Statistical heterogeneity was quantitatively evaluated by X2 test with the significance set P<0.10 or I2>50%. ResultsSeven RCTs consisting of 33,778 patients were included. (6065 normal BMI patient; 27,713 high BMI). The results showed that high BMI was related to a greater increase in operative time, post-operative range of motion (ROM), post-operative Knee Society and function scores (KSS), infection rate (P<0.1). No differences in pulmonary embolism and perioperative mortality rates were found between normal and high body mass index patients with follow-up≥5years (P>0.1). ConclusionsCompared with normal BMI patients, high BMI patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between normal and high BMI about TKA.

GENERATION OF IL-17 IMMUNE RESPONSE IN OBESE PATIENTS WITH ASTHMA

Aim - to investigate the influence of IL-17, IL-10 on the level of asthma control among obese patients. Materials and methods. 79 patients with asthma aged from 18 to 65 years were enrolled in our study and categorized into three groups according to their body mass index (BMI): group 1 - normal BMI (27 (34,2%) patients, age 50±13,8), group 2 - overweight (28 (35,4%) patients, age 44±16,5) and group 3 - obese (24 patients (30,4%), age 57,3±8,2). These patients underwent spirometry and were compared for clinical characteristics, plasma level of IL-17 and IL-10 using ELISA assay. Results. IL-17 concentrations were higher in the obese and uncontrolled asthmatics. Statistically significant correlation between the level of IL-10 and BMI was not found. Conclusions. Our study shows that cytokines IL-17 play an important role in the immune response of asthma in obese patients, and represent an important therapeutic target for the asthma treatment.

The Influence of Body Mass Index on Outcomes After Hip Arthroscopic Surgery With Capsular Plication for the Treatment of Femoroacetabular Impingement

Background: It remains unknown how variations in body mass index (BMI) influence outcomes after primary hip arthroscopic surgery with capsular plication for femoroacetabular impingement (FAI). Purpose: To evaluate the effect that abnormal BMI (namely, overweight, obese, morbidly obese, and underweight) versus normal weight has on patient-reported clinical outcomes more than 2 years postoperatively from primary hip arthroscopic surgery with capsular plication by a single surgeon. Study Design: Cohort study; Level of evidence, 3. Methods: A clinical repository containing patients undergoing primary hip arthroscopic surgery for FAI between January 1, 2012, and January 1, 2014, with a minimum 2-year follow-up was queried. Outcome measures included the Hip Outcome Score (HOS)–Activities of Daily Living (ADL), HOS-Sports, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain; satisfaction, and Patient Acceptable Symptomatic State (PASS) for the HOS-ADL; scores were collected preoperatively and at 3 months, 1 year, and minimum 2 years postoperatively. Included patients were segregated by preoperative BMI into the following categories: underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), and morbidly obese (≥35.0 kg/m2). A multivariate logistic regression model controlling for patient demographics and disease severity was used to identify independent associations between BMI categories and outcomes. A Bonferroni adjustment lowered the threshold for significance to P < .01. Results: There were 409 hips in 381 patients appropriate for study inclusion: 7 underweight, 197 normal BMI, 130 overweight, 31 obese, and 16 morbidly obese. The mean age was 33.1 ± 12.1 years, with 232 (61%) female patients. At 2 years postoperatively, significant differences in the trend among HOS-ADL, HOS-Sports, and mHHS scores were evident, with normal BMI patients, followed by underweight patients, demonstrating greater scores than their overweight, obese, and morbidly obese counterparts. Obese patients demonstrated lower satisfaction scores than normal BMI patients. Overweight, obese, and morbidly obese patients had lower improvements in VAS pain scores compared with normal BMI patients. Increasing BMI (not subdivided into the 5 BMI categories) was associated with a higher infection risk (mean BMI for infections: 32.3 ± 9.8 kg/m2 vs mean BMI for noninfections: 25.2 ± 4.8 kg/m2; P = .0035). However, with multivariate analysis, no significant differences in patient clinical outcomes between the BMI categories met the threshold for significance. Among obese patients (BMI ≥30.0 kg/m2), no specific risk factors were found to be significantly associated with decreases in the change in VAS, HOS-ADL, HOS-Sports, mHHS, satisfaction, or PASS for the HOS-ADL scores. However, because of the small cohort sizes at the extremes of the BMI categories, this analysis may have been underpowered to identify a significant difference in underweight or morbidly obese patients. Conclusion: In the current cohort, there were multiple potential confounding variables, and while some clinical differences were observed initially (higher HOS-ADL, HOS-Sports, and mHHS scores for normal BMI patients than overweight and obese patients at 2 years postoperatively; lower satisfaction scores for obese patients than normal BMI patients; and lower improvement in VAS pain scores for overweight, obese, and morbidly obese patients when compared with normal BMI patients), after multivariate analysis, no associations were observed between BMI and clinical outcomes after hip arthroscopic surgery with capsular plication for FAI.

Optimization of kV Selection on Third-generation High-pitch Dual-source Coronary CT Angiography Using Ultra-low Contrast Media Protocols in Patients with Body Mass Index between 20-30 kg/m2 under Automatic Tube Voltage Selection.

Objective To investigate the application of automatic tube voltage selection (CARE-kV)coronary CT angiography (CCTA)using ultra-low contrast media (CM)protocols in patients with body mass index (BMI)between 20 kg/m2 and 30 kg/m2 on third-generation dual-source CT (DSCT). Methods We prospectively included 134 consecutive patients with BMI between 20 kg/m2 and 30 kg/m2who underwent CARE-kV prospective high-pitch CCTA on third-generation DSCT using the ultra-low CM protocols and divided them into two groups according to the CARE-kV results:70 kV group(n=91):65 patients with normal BMI(20 kg/m2≤BMI≤25 kg/m2)and 26 patients with high BMI(25 kg/m2<BMI≤30 kg/m2);and 80 kV group(n=43):12 patients with normal BMI and 31 patients with high BMI. The 70 kV group and 80 kV group used the CM protocols of 18 ml(3.0 ml/s) and 21 ml(3.0 ml/s),respectively. The effective dose (ED),objective and subjective image quality (IQ),and results of patients in each group and subgroup were evaluated and compared.ResultsThe ED of 70 kV group was(0.24±0.04)mSv,which was 53% lower(H=3.37,P=0.02)than that of 80 kV group [(0.51±0.05)mSv]. No significant difference of CNR and SNR had been found in normal BMI patients(H=1.81,P=0.23)and high BMI patients (H=0.91,P=0.84)among 70 kV group and 80 kV group,as well as the subjective IQ in normal BMI patients(Z=0.79,P=0.76)and high BMI patients (Z=0.77,P=0.81)among 70 kV group and 80 kV group. Conclusion sWhen patients with BMI between 20 kg/m2 and 30 kg/m2 receive CARE-kV prospective high-pitch CCTA on third-generation DSCT,the CARE-kV results for a portion of patients may be higher than other patients with the same BMI level,so as to guarantee the equivalent IQ. The CARE-kV can help to select the patients' optimal tube voltage value more accurately and reasonably.

Body mass index is related with the presence of syndesmophyte in axial spondyloarthritis: Data from the Korean College of Rheumatology BIOlogics (KOBIO) registry

Objective: We investigated whether body mass index (BMI) is associated with parameters of disease activity and clinical manifestations in axial spondyloarthritis (axSpA).Methods: Demographic, clinical, and radiological features and disease activity indexes from 789 axSpA patients (619 males and 170 females) were obtained from the Korean College of Rheumatology BIOlogics (KOBIO) registry. BMI (kg/m2) was classified into normal (BMI <23.0), overweight (23.0 ≤ BMI <25.0), and obese (BMI ≥25.0). Disease activity indexes included Bath ankylosing spondylitis disease activity index (BASDAI), erythrocyte sediment rate (ESR), C-reactive protein (CRP), and ankylosing spondylitis disease activity score (ASDAS).Results: The mean BMI in patients with axSpA was 23.3 ± 3.5. 50.2% of all patients were overweight or obese. Overweight/obese patients had more syndesmophyte and less peripheral arthritis than those in normal BMI patients (p < 0.001 and p < 0.030, respectively). BMI was not associated with disease activity indexes in axSpA patients. Patients with syndesmophyte had higher BMI than those without syndesmophyte (24.2 ± 3.6 vs. 22.9 ± 3.3, p < 0.001). Multivariate logistic regression analysis showed that increased BMI was closely related with the presence of syndesmophyte (OR = 1.086, 95% CI 1.031–1.143, p = 0.002)Conclusions: Our results imply that increased BMI is significantly associated with the presence of syndesmophyte, but not with disease activity in axSpA.

Impact of body mass index on long-term mortality in women and men undergoing percutaneous coronary intervention for chronic total occlusion

BackgroundThe obesity paradox has been described in different patient populations. Data on the relation between obesity and outcomes in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are lacking. Therefore, long-term mortality in patients undergoing CTO PCI was assessed according to different body mass index (BMI) categories. MethodsA total of 1993 patients undergoing CTO PCI at a tertiary care center between January 2005 and December 2013 were divided into five different BMI categories: underweight, <18.5kg/m2; normal BMI, 18.5–24.9kg/m2; overweight, 25.0–29.9kg/m2; obese, 30.0–34.9kg/m2; and very obese, ≥35.0kg/m2. The primary endpoint was all-cause mortality. ResultsMedian follow-up was 2.6 (interquartile range 1.1–3.1) years. Of the 1993 patients, 461 (23.1%) were of normal weight, 985 (49.4%) overweight, 396 (19.9%) obese, and 144 (7.2%) very obese. Compared with normal weight BMI patients (16.3%), overweight patients had a lower all-cause mortality (10.2%, Log Rank p=0.001), while obese (11.1%, Log Rank p=0.08) and severely obese (13.2%, Log Rank p=0.39) patients had similar mortality rates. Being overweight was significantly associated with a lower all-cause mortality (HR 0.69, 95% CI 0.53–0.89, p=0.005), and associations remained significant after multivariable adjustments for confounding factors (HR 0.73, 95% CI 0.56–0.95, p=0.02). While being overweight was linked with a reduced all-cause mortality in men (HR 0.65, 95% CI 0.48–0.88, p=0.005), it was not in women (HR 1.25, 95% CI 0.60–2.52, p=0.58). ConclusionsOverweight is associated with an improved survival in patients undergoing PCI for CTO, particularly in men.

Prevalence of obesity and the effect on length of mechanical ventilation and length of stay in intensive care patients: A single site observational study

ObjectivesTo provide a snapshot of the prevalence of abnormal body mass index (BMI) in a sample of intensive care unit (ICU) patients; to identify if any medical specialty was associated with abnormal BMI and to explore associations between BMI and ICU-related outcomes. BackgroundObesity is an escalating public health issue across developed nations but there is little data pertaining to critically ill patients who require care that is expensive. MethodsRetrospective observational audit of 735 adult patients (median age 58 years) admitted to the Sir Charles Gairdner Hospital 23 bed tertiary ICU between November 2012 and June 2014. Primary outcome measure was patient BMI: underweight (<18.5kg/m2), normal weight (18.5–24.99kg/m2), overweight (25–29.99kg/m2), obese (30–39.99kg/m2) or extreme obese (40kg/m2 or above). Other measures included gender, acute physiology and chronic health evaluation II score, admission specialty, length of mechanical ventilation (MV), length of stay (LOS) and mortality. ResultsCompared to the general population there was a higher proportion of obese patients within the cohort with the majority of patients overweight (33.9%) or obese (36.5%) and median BMI of 27.9 (IQR 7.9). There were no significant differences between specialties for BMI (p=0.103) and abnormal BMI was not found to impact negatively on mortality (ICU, p=0.373; hospital, p=0.330). Normal BMI patients had shorter length of MV than other BMI categories and the impact of BMI on ICU LOS was dependent on length of MV. Overweight patients ventilated for five days or more had a shorter LOS, and extremely obese non-ventilated patients had a longer LOS, compared to normal weight patients. ConclusionsAlthough the obesity–disease relationship is increasingly complex and data presented reflects categorical BMI for patients admitted to a single ICU site it may be important to consider the cost implications of caring for this cohort especially with regard to MV and LOS.

Operative Risk for Major Lung Resection Increases at Extremes of Body Mass Index

Although body mass index (BMI) has been used in risk stratification for lung resection, many models only take obesity into account. Recent studies have demonstrated that underweight patients also experience increased postoperative complications. We explored the relationship of extremes of BMI to outcomes after lung resection for non-small cell cancer. Patients in the Society of Thoracic Surgeons General Thoracic Surgery Database (2009 to 2014) undergoing elective lung resection for cancer were evaluated. Multivariable logistic regression was used to adjust for potential confounders including functional status and spirometry. We evaluated 41,446 patients (median 68 years of age; 53% female) grouped by BMI: underweight (<18.5 kg/m2; 3.0%), normal (18.5 to 24.9 kg/m2; 33.5%), overweight (25 to 29.9 kg/m2; 35.4%), obese I (30 to 34.9 kg/m2; 18.1%), obese II (35 to 39.9 kg/m2; 6.4%), and obese III (≥40 kg/m2; 3.6%). Pulmonary complication rates were higher in underweight and obese III patients compared to normal BMI patients (p < 0.001). On multivariable analysis, compared to patients with normal BMI, being underweight was associated with an increased risk of pulmonary complications (adjusted odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.16 to 1.70) and any postoperative event (adjusted OR: 1.44, 95% CI: 1.26 to 1.64). Obese III patients had an increased risk of any major postoperative complication (adjusted OR: 1.18, 95% CI: 1.02 to 1.36). Overweight and obese class I to II patients had a lower risk of pulmonary complications and any postoperative event. BMI is associated with postoperative complications after lung resection for cancer. Being underweight or severely overweight is associated with an increased risk of complications, whereas being overweight or moderately obese appears to have a protective effect.

Elevated Body Mass Index Is Associated With Early Total Knee Revision for Infection

BackgroundObesity affects over half a billion people worldwide, including one-third of men and women in the United States. Obesity is associated with higher postoperative complication rates after total knee arthroplasty (TKA). It remains unknown whether obese patients progress to revision TKA faster than nonobese patients. MethodsA total of 666 consecutive primary TKAs referred to an academic tertiary care center for revision TKA were retrospectively stratified according to body mass index (BMI), reason for revision TKA, and time from primary to revision TKA. ResultsWhen examining primary TKAs referred for revision TKA, increasing BMI adversely affected the mean time to revision TKA. The percent of referred TKAs revised by 5 years was 54% for a normal BMI, 64% for an overweight patient, 71% for an obese class I patient, 68% for an obese class II patient, and 73% for a morbidly obese patient. There was a significant difference in time to revision TKA between patients with normal BMI and elevated BMI (P = .005). There was a significant increase in early revision TKA for infection in patients with an elevated BMI (54%, 74/138) when compared with the normal BMI patients (24%, 8/33, P < .003, relative risk ratio = 2.3, absolute risk = 30%, number needed to treat = 3.3). There was no significant increase in acute, early, midterm, or late revision TKA for aseptic loosening and/or osteolysis, instability, stiffness, or other causes between patients with normal BMI and elevated BMI. ConclusionAn elevated BMI is a risk factor for early referral to a tertiary care center for revision TKA. Specifically, orthopedic surgeons should convey to overweight and obese patients that they have at least a 130% increased relative risk and a 30% absolute risk of revision TKA for an early infection if referred for revision TKA. Patient expectations and counseling as well as reimbursement should account for the greater risks when performing a TKA on patients with an elevated BMI.

Liver regeneration after major liver hepatectomy: Impact of body mass index

Obese patients may present with metabolic abnormalities that impact liver regeneration. We sought to assess the impact of body mass index (BMI) on liver volume regeneration index (RI) and kinetic growth rate (KGR) among patients undergoing liver resection. The study included 102 patients undergoing major hepatectomy (≥3 segments) between July 2004 and April 2015 and stratified the patients by preoperative BMI, number of segments resected, and postoperative remnant liver volume (RLVp) to total liver volume ratio. Resected volume at operation was subtracted from total liver volume to calculate postoperative RLVp. RI was defined as the relative increase in RLV within 2months [(RLV2m-RLVp)/RLVp] and 7months [(RLV7m-RLVp)/RLVp] postoperatively; KGR was calculated as RI divided by time postoperatively (weeks). Median patient age was 59.6years (interquartile range 48.1-68.7years), and most patients were men (52.0%). Liver failure was associated with the KGR at 2months (KGR2m) and was greater among patients with KGR2m <2.5% per week (KGR <2.5%, 18.5% vs KGR≥2.5%, 4.6%; P=.04). Although RI and KGR within 2 and 7months postoperatively were similar among all patients, after excluding patients with fibrosis, obese (0.42% per week) and overweight patients (0.29% per week) had lesser KGR2-7m compared with patients of normal BMI (0.82% per week; P<.05). Additionally, risk of a major complication was greatest among obese patients (normal weight, 8.1% vs overweight, 12.9% vs obese, 29.4%; P=.04). BMI did not impact liver regeneration during the first 2months. In contrast, KGR per week between 2 and 7months postoperatively was less among overweight and obese patients.

Effect of Body Mass Index on Outcomes in Left Ventricular Assist Device Recipients.

Obesity is associated with higher mortality following heart transplantation, but there remains no consensus regarding outcomes in left ventricular assist device (LVAD) recipients. We sought to determine the impact of body mass index (BMI) on outcomes in patients undergoing LVAD implantation. This was a single-institution retrospective review, including all patients who received a HeartMate II LVAD or HeartWare HVAD between March 2006 and June 2014. Patients were stratified into three groups based on normal (<25 kg/m(2) ), overweight (25-30 kg/m(2) ), and obese (>30 kg/m(2) ) BMI. Two hundred patients were included in the analysis. Mean BMI was 28.3 kg/m(2) , (27% normal, 36% overweight, and 36.5% obese). Obese patients were younger (51.9 years, p = 0.03) and had higher incidence of diabetes (58.9% vs. 24.1%; p < 0.001) and peripheral vascular disease (16.4% vs. 1.9%; p = 0.03). Normal BMI patients were more likely to undergo LVAD implantation as destination therapy compared to the overweight and obese groups (67% vs. 39% vs. 51%; p = 0.01) and had higher incidence of postoperative stroke/transient ischemic attack (22.2% vs. 6.9% vs. 12.3%; p = 0.04) and postoperative bleeding requiring reoperation (27.8% vs. 12.5% vs. 9.6%; p = 0.01). Survival at one, three, and five years was similar across all BMI groups. BMI was not an independent predictor of overall survival. Appropriately-selected patients at the extremes of BMI can safely undergo LVAD implantation with no difference in survival. BMI should not in itself be considered a contraindication to LVAD placement.

Body mass index at mCRPC, weight change, and survival in advanced prostate cancer.

270 Background: Body mass index (BMI) at diagnosis is associated with increased risk of fatal prostate cancer, but the link between BMI at mCRPC and cancer progression is less clear. Cachexia, often defined as involuntary weight loss &gt; 5% over 6 months, is common in advanced cancers. The goal of this study was to examine the link between BMI at mCRPC and weight change as it relates to cancer progression, the outcomes of survival, and treatment use in a single-institution setting. Methods: 58 mCRPC patients treated at Tulane Hospital were identified, 41 of whom had an overweight BMI at mCRPC (BMI &gt; 25) and 17 with normal BMI at mCRPC (BMI &lt; 25). All patients had a confirmed prostate cancer death. Survival, treatment history, and percent weight change were compared according to BMI status. Rate of percent weight change was defined as the change in weight per day, from date of mCRPC diagnosis to the last treatment stop date or death date (“mCRPC days”). Linear regression, overall survival (OS), and nonparametric analyses were performed. Results: There was no significant difference between the normal and overweight BMI groups in overall survival, from date of diagnosis to death (median = 1835 days vs. 2710 days respectively). Additionally, the difference in survival from mCRPC to death was not statistically significant (median = 630 days vs. 799 days, p = 0.115). Use of Taxotere was not significantly different (47% vs. 68% respectively); however, overweight patients (n = 28) more likely received Abiraterone than normal BMI patients (n = 2) (p-value = 0.0001). The rate of percent weight change was significantly different for normal and overweight patients (mean = –0.050%/day vs. –0.019%/day, p = 0.003). Linear regression analysis showed that mCRPC days had a significant effect on percent weight change (p = 0.0109), and this effect was not significantly different between BMI groups (p = 0.6991). Conclusions: Survival after mCRPC was not significantly different between BMI groups. We observed a significant effect of mCRPC days on percent weight change, with a similar effect for both BMI groups. This outcome is expected, as more time would allow for greater weight changes to occur. Larger studies are needed to fully evaluate these observations.

Accidental Dural Puncture Management: 10-Year Experience at an Academic Tertiary Care Center.

The use of spinal catheters for extended periods after accidental dural puncture (ADP) and administration of intrathecal saline via spinal catheters have been advocated to decrease the incidence of postdural puncture headache and the subsequent need for epidural blood patch (EBP), with mixed results observed. We reviewed the medical records of 218 patients with ADP who either had the epidural resited or had a spinal catheter (with or without the administration of intrathecal saline). We compared the incidence of headache and the need for blood patch between these groups. We also assessed complications when a standard lidocaine epidural test dose was administered intrathecally and compared this with complications when a solution normally used for labor combined spinal epidurals was administered. There was no difference in the incidence of postdural puncture headache between the resited epidural group and the spinal catheter group, 68.0% versus 55.9% (odds ratio [OR], 1.7; 95% confidence interval [95% CI], 1.0-2.9; P = 0.07). Resiting the epidural catheter was associated with a significant increase in the number of EBPs when compared with using a spinal catheter, 52.0% versus 20.3% (OR, 4.2; 95% CI, 2.4-7.6; P < 0.001) and when compared with spinal catheters with intrathecal saline, 52.0% versus 8.1% (OR, 12.3; 95% CI, 4.3-35.4; P < 0.001). There was a significant difference in the number of blood patches between normal body mass index patients and morbidly obese patients, 55.2% versus 25.0% (OR, 3.7; 95% CI, 1.2-11.2; P = 0.02). Complications (hypotension prompting pressors, high spinal, and emergency cesarean delivery because of nonreassuring fetal status) occurred more frequently when a lidocaine test dose was immediately administered after ADP versus administering a labor combined spinal epidural solution. Insertion of spinal catheters after ADP and administration of intrathecal normal saline via spinal catheters reduce the need for EBP compared with resiting the epidural. Administration of the standard epidural test dose intrathecally is associated with frequent and significant complications.

Transforaminal full-endoscopic lumbar discectomy in obese patients.

Obese patients are at risk of complications such as slower wound healing and increased infection rates after spinal surgery. Transforaminal full-endoscopic lumbar discectomy (ELD) has advantages over conventional microdiscectomy because it decreases perioperative complications and increases favorable clinical outcomes. No clinical studies have reported ELD in obese patients. The purpose of this study is to evaluate the clinical outcomes of transforaminal ELD in obese patients. Obesity is defined as a body mass index (BMI) of more than 30 kg/m2. Our study included 21 obese patients and 27 normal BMI patients treated by posterolateral transforaminal ELD for radiating pain caused by a single-level lumbar disc herniation with more than 2 years of follow-up. Clinical chart reviews and telephone surveys were conducted. Clinical and functional outcomes using VAS and ODI, perioperative complications, and reherniation were evaluated. Overall clinical and functional outcomes were improved during postoperative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In obese group, three patients had late reherniations. Of these, 2 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient who had undergone ELD for recurrent disc herniation underwent open microdiscectomy. In control group, two patients had early reherniation and underwent open microdiscectomy and one patient with late reherniation showed good recovery with conservative treatment. In select cases, ELD is an effective, safe, and minimally invasive technique for obese patients. It decreases perioperative morbidity and allows for both early mobilization and early return to work. level 3b.

Body mass index association with survival in severe aortic stenosis patients undergoing transcatheter aortic valve replacement.

Conflicting results have been reported regarding impact of body mass index (BMI) on outcome of transcatheter aortic valve replacement (TAVR) patients. This study evaluates the impact of BMI on 1 year mortality in patients undergoing TAVR via the transfemoral (TF) access. Aortic stenosis (AS) patients undergoing TAVR via a TF access between May 2007 and December 2014 were categorized to 4 groups by BMI: low (<20), normal (20-24.9), overweight (25-30), and obese (>30). Baseline parameters were compared, and multivariate Cox proportional hazard regression models were generated to assess outcome differences. Among 491 severe AS TAVR patients, 43 had low BMI, 148 had normal BMI, 162 were overweight, and 138 were obese. Obese patients were younger with lower Society of Thoracic Surgeons scores and higher rates of preserved ejection fraction and diabetes. There was a higher rate of women in the BMI extremes. Aortic valve area was higher among obese patients; however, the indexed area was inversely correlated with BMI. Vascular complications and transfusions were more common in the low-BMI group, while acute kidney injury was more common in obese patients. All-cause mortality at 1 year was higher in the low-BMI group (log-rank p = 0.003) with no significant difference among normal and above-normal BMI patients. In a multivariate model, BMI <20 kg/m(2) was an independent predictor of mortality (HR = 2.45, p = 0.01). BMI <20 kg/m(2) should be considered a frailty marker during the screening process of severe AS TAVR patients as it is associated with higher mortality, while obesity confers similar mortality risk as normal weight. © 2015 Wiley Periodicals, Inc.

Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit.

To assess the effect of body mass index on ICU outcome and on the development of ICU-acquired infection. A substudy of the Intensive Care Over Nations audit. Seven hundred thirty ICUs in 84 countries. All adult ICU patients admitted between May 8 and 18, 2012, except those admitted for less than 24 hours for routine postoperative monitoring (n = 10,069). In this subanalysis, only patients with complete data on height and weight (measured or estimated) on ICU admission in order to calculate the body mass index were included (n = 8,829). None. Underweight was defined as body mass index less than 18.5 kg/m, normal weight as body mass index 18.5-24.9 kg/m, overweight as body mass index 25-29.9 kg/m, obese as body mass index 30-39.9 kg/m, and morbidly obese as body mass index greater than or equal to 40 kg/m. The mean body mass index was 26.4 ± 6.5 kg/m. The ICU length of stay was similar among categories, but overweight and obese patients had longer hospital lengths of stay than patients with normal body mass index (10 [interquartile range, 5-21] and 11 [5-21] vs 9 [4-19] d; p < 0.01 pairwise). ICU mortality was lower in morbidly obese than in normal body mass index patients (11.2% vs 16.6%; p = 0.015). In-hospital mortality was lower in morbidly obese and overweight patients and higher in underweight patients than in those with normal body mass index. In a multilevel Cox proportional hazard analysis, underweight was independently associated with a higher hazard of 60-day in-hospital death (hazard ratio, 1.32; 95% CI, 1.05-1.65; p = 0.018), whereas overweight was associated with a lower hazard (hazard ratio, 0.79; 95% CI, 0.71-0.89; p < 0.001). No body mass index category was associated with an increased hazard of ICU-acquired infection. In this large cohort of critically ill patients, underweight was independently associated with a higher hazard of 60-day in-hospital death and overweight with a lower hazard. None of the body mass index categories as independently associated with an increased hazard of infection during the ICU stay.

Are overweight and obese patients who receive autologous free-flap breast reconstruction satisfied with their postoperative outcome? A single-centre study

Obese and overweight patients represent a challenging surgical group for autologous free-flap breast reconstruction. There is a paucity of information regarding post-operative patient-reported satisfaction in this increasingly prevalent cohort. This retrospective study aimed to determine using BREAST-Q patient-reported satisfaction amongst normal, overweight and obese patients receiving autologous free-flap breast reconstruction. BREAST-Q (post-reconstruction) module was sent to 174 autologous breast free flap reconstruction patients between 2001 and 2012. Clinical data were collated for patients who returned questionnaires. Post-operative complications and satisfaction scores were compared between normal versus overweight and obese patients. A total of 101 patients (normal body mass index (BMI) = 27; overweight BMI = 48 and obese BMI = 25) completed BREAST-Q (response rate 66%). Obese and overweight patients are significantly more likely to develop major (44.8% and 31.1% vs. 29.6%) and minor (34.4% and 20% vs. 7.4%) complications in comparison to normal BMI patients (p < 0.02). Overweight and obese patients demonstrated similar levels of satisfaction compared with normal patients with the shape of their reconstructed breasts (73.2 and 72.1 vs. 71.2; p > 0.05) and overall surgical outcome (75.8 and 78.9 vs. 75.4; p > 0.05). Patient post-operative satisfaction is gaining increasing relevance in assessing the outcomes from autologous breast reconstruction. Overweight and obese women benefit from autologous breast reconstruction, despite being at increased risk of post-operative complications, and eventually achieve comparable levels of post-operative satisfaction. This should be reflected in pre-operative counselling.

The Effect of Body Mass Index on Perioperative Outcomes After Major Surgery: Results from the National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2011.

Obesity is associated with poor surgical outcomes and disparity in access-to-care. There is a lack of quality data on the effect of body mass index (BMI) on perioperative outcomes. Accordingly, we sought to determine the procedure specific, independent-effect of BMI on 30-day perioperative outcomes in patients undergoing major surgery. Participants included individuals undergoing one of 16 major surgery (cardiovascular, orthopedic, oncologic; n = 141,802) recorded in the ACS-NSQIP (2005-2011). Outcomes evaluated included complications, blood transfusion, length-of-stay (LOS), re-intervention, readmission, and perioperative mortality. Multivariable-regression models assessed the independent-effect of BMI on outcomes. Nearly, 74 % of patients had a BMI disturbance; the majority being overweight (35.3 %) or obese (29.8 %). Morbidly obese patients constituted a small but significant proportion of the patients (5.7 %; n = 8067). In adjusted-analyses, morbidly obese patients had significantly increased odds of wound complications in 15 of the examined procedures, of renal complications after 6-procedures, of thromboembolism after 5-procedures, of pulmonary, septic and UTI complications after 2-procedures, and of cardiovascular complications after CABG. Conversely, obese/overweight patients, except for increased odds of wound complications after select procedures, had significantly decreased odds of perioperative mortality, prolonged-LOS and blood transfusion relative to normal BMI patients after 4, 8, and 9 of the examined procedures. The prevalence of BMI derangements in surgical patients is high. The effect of BMI on outcomes is procedure specific. Patients with BMI between 18.5 and 40-kg/m(2) at time of surgery fare equally well with regard to complications and mortality. However, morbidly obese patients are at-risk for postsurgical complications and targeted preoperative-optimization may improve outcomes and attenuate disparity in access-to-care.

Predictors of recurrence of umbilical hernias following primary tissue repair in obese veterans

BackgroundFactors that determine recurrence and complications following primary tissue repair of umbilical hernias (UHs) and the approach to repair UHs in obese patients need further analysis. MethodsA retrospective review of UH repair (UHR) conducted at our institution was undertaken. Patients were grouped by body mass index (BMI) and compared for recurrence and complications. Univariate and multivariate analyses were performed. ResultsIn total, 199 patients (BMI 32.3 kg/m2, 97% male, 77% Caucasian, American Society of Anesthesiologists class III/IV 59.2%) underwent primary tissue UHR. There were 8 recurrences (4.0%); average follow-up 3.9 ± 2.4 years (range 30 days to 9.2 years). There were no recurrences among normal BMI patients (0/11); 3 in overweight (3/54), 2 in class I obese (2/73), 2 in class II obese (2/47), and 1 in morbidly obese (1/14) patients (P = .84). Albumin and American Society of Anesthesiologists were similar in all groups. Recurrence rates among obese and nonobese patients were not significantly different (3.7% vs 4.6%, P = .72). There were 18 (9.0%) complications. BMI was not associated with complications. ConclusionPrimary tissue repair is a feasible approach for UHR in obese patients.

Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer

BackgroundAmong patients undergoing resection for gastric cancer, the impact of body mass index (BMI) on outcomes is not well understood. We sought to define the impact of non-normal BMI on short- and long-term outcomes after gastric cancer resection. MethodsWe identified 775 patients who underwent gastrectomy for adenocarcinoma between 2000 and 2012 from the multi-institutional US Gastric Cancer Collaborative. Clinicopathologic characteristics, operative details, and oncologic outcomes were collected, and patients were stratified according to BMI. ResultsMost patients in the cohort were classified as having normal BMI (n = 338, 43.6%), followed by overweight (n = 229, 29.6%), obese (n = 153, 19.7%), and underweight (n = 55, 7.1%). After stratifying by BMI, there were no significant differences in the incidence of postoperative blood transfusions, perioperative morbidity, postoperative infectious complications, length of stay, perioperative 30-d in-hospital death, or readmission across groups (all P > 0.05). BMI did not impact overall or recurrence-free survival after stratifying by stage (all P > 0.05). However, underweight patients with low preoperative albumin levels had worse overall survival (OS) compared with that of patients of normal BMI. ConclusionsBMI did not impact perioperative morbidity, recurrence-free, or OS in patients undergoing gastric resection for adenocarcinoma. Underweight patients with BMI <18.5 kg/m2 and low preoperative albumin levels, however, had a significantly decreased OS after gastrectomy for cancer. These high-risk patients should have their nutritional status optimized both before and after gastrectomy in an attempt to modify this risk factor and, in turn, achieve better outcomes.