Postoperative Complications In Obese Patients Research Articles

The Effect of Obesity on Surgical Outcomes in General Surgery Patients: A Systematic Review of 1,680,694 patients

The study examined the impact of obesity on general surgery patients, analyzing eleven studies with 1,680,694 patients. Results showed that obesity increases postoperative wound infection risk, blood loss, and recovery times. However, prospective studies found no increase in surgical complications or hospitalization expenses. Obesity may protect against venous thromboembolism and death, but post-operative complications in obese patients undergoing general surgical procedures remain controversial due to metabolic, pharmacologic, and systemic illnesses. Obesity increases surgical duration and SSIs, potentially increasing immediate complications.

Comparison of abdominal adipose tissue versus body mass index (BMI) as a predictor of complications and survival in liver transplantation

IntroductionBecause of the obesity epidemic, more obese patients are on liver transplant (LT) waiting lists. The diseases associated with obesity may increase complications and limit survival after LT. However, there is no established measure or cut-off point to determine this impact and aid decision making. The aim of the present study is to evaluate obesity in patients undergoing LT via BMI and CT-based measurement of adipose tissue (AAT). These parameters will be used to predict the risk of postoperative complications and 5-year survival. MethodsA retrospective, single-center study was carried out at a tertiary Spanish hospital, including all patients who received LT between January 2012 and July 2019 (n = 164).The patients were adults who underwent LT using the ‘piggyback’ technique, preserving the recipient vena cava. Visceral adipose tissue (VAT) and BMI were calculated to examine correlations with postoperative complications and 5-year survival. ResultsNo significant association was found between postoperative complications by Comprehensive Complication Index, BMI, AAT/height, subcutaneous fat/height and VAT/height.Kaplan-Meier curves for 5-year survival compared LT recipients with BMI < 30.45 versus ≥30.45, with an estimated survival of 58.97 months versus 43.11 months, respectively (P < .001) (Fig. 3) and for LT recipients with an AAT/height <27.35 mm versus ≥27.35 mm, with an estimated survival of 57.69 months versus 46.34 months (P = .001). ConclusionsThis study does not show a higher rate of postoperative complications in obese patients. There is a significantly lower long-term survival in patients with AAT/height ≥27.35 mm and BMI ≥ 30.45. BMI is a valid estimate of obesity and is predictive of survival.

The Effect of Obesity on Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures.

Obesity is a well-recognized global epidemic that can lead to longer operative times as well as a greater technical demand. Despite this, the available literature evaluating the impact of obesity on hip hemiarthroplasty (HA) and total hip arthroplasty (THA) when treating fractures about the femoral neck is scarce. Between 2015 and 2018, we retrospectively reviewed all patients that had a HA or THA performed as treatment for an isolated fracture of the femoral neck. Patients were classified as obese and nonobese depending on current body mass index (BMI) when the index procedure was performed. Preoperative and postoperative variable were obtained from the electronic medical record. A total of 157 patients underwent hip HA or THA for an isolated fracture of the femoral neck. In those patients undergoing HA, obesity was associated with an increase in operative times (P = 0.021) and was associated with a nonsignificant increase in total operating room time (P = 0.088) and duration of anesthesia (P = 0.14). In those patients undergoing THA, obesity was associated with longer operative times (P = 0.043), total operating room time (P = 0.032), and duration of anesthesia (P = 0.045). There were no significant differences in complication rates postoperatively between obese and non-obese patients undergoing either procedure. The treatment of isolated fractures of the femoral neck with HA or THA leads to an increase in operative time without an increase in postoperative complications in obese patients.

The Effect of Body Mass Index on Open Carpal Tunnel Release Recovery

The purpose of this study was to determine whether a relationship exists between body mass index (BMI), specifically obesity, and surgical outcomes for open carpal tunnel release. Obesity is correlated with increased incidence of carpal tunnel syndrome; however, the effect of obesity on after release recovery has not been examined. This study used a retrospective review of patient charts (n= 142). BMI was calculated based on height and weight measurements, and patients were grouped based on their BMI into the following categories: healthy BMI (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class one (30-34.9 kg/m2) (OB1), obesity class (2 35-39.9 kg/m2) (OB2), or obesity class three (40+ kg/m2) (OB3). Data were then complied on surgical outcomes by assessing preoperative pain, postoperative pain at 2 and 6 weeks, postoperative joint stiffness, wound healing time, and infection status. Data were analyzed using chi-square analyses and multivariable logistic regression to assess the differences in treatment outcomes while controlling for possible confounding variables. Age at the time of release was found to be inversely correlated with BMI. Healthy BMI patients (n= 19) underwent release at an average age of 59.1 years, whereas OB3 (n= 30) underwent release at an average age of 46.9 years. The odds of improvement in pain were significantly lower in all three obesity groups when compared with healthy BMI at both 2 and 6 weeks after operation. Our results indicate that obesity may be positively correlated with earlier incidence of carpal tunnel syndrome requiring surgical intervention. These data also indicate the increased rates of postoperative complications in obese patients, particularly patients with OB3. Patients with OB3 need to understand these risks before undergoing open release. Further study should examine the impact of type 2 diabetes on carpal tunnel release recovery. The information included in this study may be used to guide surgeons and patients when considering the effect and potential improvement in outcomes that may come from addressing patient BMI before open carpal tunnel surgery.

Minimally invasive approaches increase postoperative complications in obese patients undergoing pancreaticoduodenectomy during the initial development period: a propensity score matching study.

Obesity increases surgical risks in various abdominal surgeries and its impact on open pancreaticoduodenectomy (OPD) and minimally invasive pancreaticoduodenectomy (MIPD) remains unknown. This study aimed to compare the surgical outcomes of OPD and MIPD in obese and non-obese patients by propensity score matching (PSM) analysis during the implementation of MIPD. We retrospectively reviewed all pancreaticoduodenectomies from December 2014 to May 2021. Obesity was defined as body mass index > 25kg/m2 according to World Health Organization International Obesity Task Force. PSM was used to minimize the selection bias of MIPD. Among 462 pancreaticoduodenectomies (339 OPDs, 123 MIPDs), there were 313 patients in the non-obese group (MIPD: 78, OPD: 235) and 149 patients in the obese group (MIPD: 45, OPD: 104). After PSM, there were 70 MIPD/106 OPD patients in the non-obese group and 38 MIPD/54 OPD patients in the obese group. The obese MIPD patients had more fluid collection (36.8% vs 9.8%, p = 0.002), a higher Clavien-Dindo (CD) grade (p = 0.007), more major complications (42.1% vs 14.8%, p = 0.004), and longer operative times (306min vs 264min, p < 0.001) than the obese OPD patients. The non-obese MIPD patients had lower CD grades (p = 0.02), longer operative times (294 vs 264min, p < 0.001), and less blood loss (100mL vs 200mL) than the non-obese OPD patients. MIPD was a strong predictor of major complication (CD ≥ 3) in obese patients (odds ratio 3.11, 95% CI: 1.40-6.95, p = 0.005). Minimally invasive approaches deteriorate the CD grade, fluid collection, and major complications in obese patients undergoing pancreaticoduodenectomy during the initial development period. Non-obese patients may benefit from MIPD over OPD in terms of less blood loss and lower CD grades. The impact of BMI on MIPD should be considered when assessing the surgical risks.

Obesity: A risk factor for postoperative complications in laparoscopic surgery for colorectal cancer.

The prevalence of obesity in the Eastern Mediterranean is increasing significantly up to 20.8% in 2016. Therefore, a higher percentage of colorectal cancer (CRC) patients are expected to be obese. Laparoscopic colorectal cancer surgery (LCRCS) is regarded as a safe and feasible procedure as laparoscopic approach is becoming the gold standard in CRC surgery, especially in the early stages of disease. However, LCRCS is correlated with a higher risk of short-term post-operative complications in obese patients (body mass index [BMI] ≥30 Kg/m 2 ) than in patients with BMI <30 Kg/m 2 . This study aims to evaluate the impact of obesity on short-term post-operative complications in patients undergoing LCRCS. A retrospective study was conducted. Clinical data of case and control patients were extracted from medical records. These patients underwent LCRCS between January 2018 and June 2021 at Hôtel-Dieu de France Hospital, Beirut-Lebanon. Patients were divided into two groups: obese and non-obese. BMI ≥30 Kg/m 2 was used to define obese patients. Post-operative complications in the 30 days following surgery were the primary outcome. The severity of post-operative complications was evaluated using the Clavien-Dindo score. Chi-square test was used to evaluate the statistical correlation between collected variables. We identified 107 patients who underwent LCRCS during this study period at our institution. Among the patients, 23 were obese (21.49%). At 30 days post-operative, 26 patients were reported to having at least one complication. Non-significant differences were found between the two groups regarding the early post-operative complications rate (obese 26.1% and non-obese 23.8% with P = 0.821). Obesity was not demonstrated as a stratification risk by severity of the early post-operative complications ( P = 0.92). Obesity, which was defined as BMI ≥30 Kg/m 2 , was not a risk factor for early post-operative complications as well as a stratification risk by severity of post-operative complications in LCRCS.

Effect of obesity on post-operative outcomes following colorectal cancer surgery.

BACKGROUNDColorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.AIMTo evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.METHODSSix-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index (BMI): Obese [BMI ≥ 30, n = 182 (29.6%)] and non-obese [BMI < 30, n = 433 (70.4%)]. Demographics, comorbidities, surgical features, and post-operative outcomes were compared between both groups. Post-operative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery [n = 472: BMI ≥ 30, n = 136 (28.8%); BMI < 30, n = 336 (71.2%)].RESULTSObese patients had a higher burden of cardiac (73.1% vs 56.8%; P < 0.001) and respiratory comorbidities (37.4% vs 26.8%; P = 0.01). Obese patients were also more likely to undergo conversion to an open procedure (12.8% vs 5.1%; P = 0.002), but did not experience more post-operative complications (51.6% vs 44.1%; P = 0.06) or high-grade complications (19.2% vs 14.1%; P = 0.11). In the laparoscopic subgroup, however, obesity was associated with a higher prevalence of post-operative complications (47.8% vs 39.3%; P = 0.05) but not high-grade complications (17.6% vs 11.0%; P = 0.07).CONCLUSIONSurgical resection of CRC in obese individuals is safe. A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.

Obstructive apnea syndrome as a risk factor for the development of postoperative complications in obese patients

Introduction. Early detection of patients with obstructive sleep apnea syndrome (OSAS) using preoperative screening is necessary to reduce risks in the perioperative period.The objective was to assess the effect of OSAS on the perioperative management of patients.Methods and materials. 54 patients with a BMI of more than 30 kg/m2 were examined, for whom a bariatric operation was performed as planned. Before the operation, all patients underwent respiratory polygraph with the calculation of the apnea/ hypopnea index (AHI), mean saturation (SpO2 m) during sleep and spirometry.Results. Patients were divided into 2 groups according to AHI: gr. 1 (n=33) with AHI&lt;15/hour, OSAS, gr. 2 (n=21) with a AHI ≥15/hour. In gr. 2 VC and FVC should be significantly lower than in gr. 1 (p&lt;0.01). A significant decrease in SpO2 m was noted (p&lt;0.001). On the first day after the operation, there was an increase in pCO2 of arterial blood in gr. 2, in comparison with gr. 1 (p&lt;0.05).Conclusions. OSAS can be considered as an independent adverse risk factor for potential perioperative complications. Early detection of OSAS will reduce the risks of postoperative complications.

Ethnic Disparities and Incidence of Postoperative Complications in Obese Patients Undergoing Total Knee Arthroplasty: Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Set.

Total knee arthroplasty (TKA) is common but complex operation. A paucity of literature exists on differences between Hispanics and non-Hispanics with TKA. Our study aims to investigate the association between Hispanic ethnicity and complications in obese patients undergoing TKA. This is a retrospective cohort study using the National Surgical Quality Improvement Program database for patients with body mass index ≥30 kg/m2 who underwent TKA. Exposure in this study was ethnicity (Hispanic versus non-Hispanic), and the primary outcome was postoperative complications. Associations between ethnicity and baseline characteristics and between covariates and the outcome were assessed via bivariate analysis. Multiple logistic regression was done to determine associations between Hispanic ethnicity and complications while controlling for confounders. Thirty five thousand twenty-seven patients were included in our study, of which 6.3% were Hispanic. Among obese adults, Hispanics had a 1.24 (95% CI 1.11 to 1.39) times greater odds of having a postoperative complication after TKA than non-Hispanics. This increased to 1.36 (95% CI 1.20 to 1.54) after adjusting for confounders. Hispanics were notably more likely to receive transfusion (2.62% vs. 1.59%, P < 0.001) and have prolonged length of stay (13.29% vs. 11.12%, P = 0.002) but were less likely to have wound disruption (0.05% vs. 0.27%, P = 0.042). In a national database, Hispanic ethnicity was associated with greater odds of postoperative complication in obese patients undergoing TKA compared with non-Hispanics. Future studies focusing on a wide range metrics of social determinants of health are needed to further investigate barriers and intervention to eliminate racial/ethnic disparities in surgical patients.

Neoadjuvant chemotherapy does not disproportionately influence post-operative complication rates or time to chemotherapy in obese patients with advanced-stage ovarian cancer

ObjectivesTo determine whether neoadjuvant chemotherapy (NACT) disproportionately benefits obese patients. MethodsData were collected from stage IIIC-IV ovarian cancer patients treated between 01/2010–07/2015. We performed univariate/multivariate logistic regression analyses with post-operative infection, readmission, any postoperative complication, and time to chemotherapy as outcomes. An interaction term was included in models, to determine if the effect of NACT on post-operative complications was influenced by obesity status. ResultsOf 507 patients, 115 (22.6%) were obese and 392 (77.3%) were non-obese (obese defined as BMI ≥30). Among obese patients undergoing primary debulking surgery (PDS) vs. NACT, rates of postoperative infection were 42.9% vs. 30.8% (p = 0.12), 30-day readmission 30.2% vs. 11.5% (p < 0.02), and any post-operative complication were 44.4% vs 30.8% (p = 0.133). Among non-obese patients undergoing PDS vs. NACT, rates of post-operative infection were 20.0% vs. 12.9% (p = 0.057), 30-day readmission 16.9% vs. 9.2% (p = 0.02), and any post-operative complication were 19.4% vs 28% (p = 0.044). Obesity was associated with post-operative infection (OR 2.3; 95%CI 1.22–4.33), 30-day readmission/reoperation (OR 2.27; 95%CI 1.08–3.21) and the development of any post-operative complication (OR 2.1; CI 1.13–3.74). However, there was not a significant interaction between obesity and NACT in any of the models predicting post-operative complications. ConclusionsThe decision to use NACT should not be predicated on obesity alone, as the reduction in post-operative complications in obese patients is similar to non-obese patients.

Adverse Outcomes in Obese Cardiac Surgery Patients Correlates With Altered Branched-Chain Amino Acid Catabolism in Adipose Tissue and Heart.

Background: Predicting relapses of post-operative complications in obese patients who undergo cardiac surgery is significantly complicated by persistent metabolic maladaptation associated with obesity. Despite studies supporting the linkages of increased systemic branched-chain amino acids (BCAAs) driving the pathogenesis of obesity, metabolome wide studies have either supported or challenged association of circulating BCAAs with cardiovascular diseases (CVDs).Objective: We interrogated whether BCAA catabolic changes precipitated by obesity in the heart and adipose tissue can be reliable prognosticators of adverse outcomes following cardiac surgery. Our study specifically clarified the correlation between BCAA catabolizing enzymes, cellular BCAAs and branched-chain keto acids (BCKAs) with the severity of cardiometabolic outcomes in obese patients pre and post cardiac surgery.Methods: Male and female patients of ages between 44 and 75 were stratified across different body mass index (BMI) (non-obese = 17, pre-obese = 19, obese class I = 14, class II = 17, class III = 12) and blood, atrial appendage (AA), and subcutaneous adipose tissue (SAT) collected during cardiac surgery. Plasma and intracellular BCAAs and BC ketoacids (BCKAs), tissue mRNA and protein expression and activity of BCAA catabolizing enzymes were assessed and correlated with clinical parameters.Results: Intramyocellular, but not systemic, BCAAs increased with BMI in cardiac surgery patients. In SAT, from class III obese patients, mRNA and protein expression of BCAA catabolic enzymes and BCKA dehydrogenase (BCKDH) enzyme activity was decreased. Within AA, a concomitant increase in mRNA levels of BCAA metabolizing enzymes was observed, independent of changes in BCKDH protein expression or activity. BMI, indices of tissue dysfunction and duration of hospital stay following surgery correlated with BCAA metabolizing enzyme expression and metabolite levels in AA and SAT.Conclusion: This study proposes that in a setting of obesity, dysregulated BCAA catabolism could be an effective surrogate to determine cardiac surgery outcomes and plausibly predict premature re-hospitalization.

Operating on the Edge? Body Contouring Procedures in Patients with Body Mass Index Greater 35.

Body contouring surgery after massive weight loss was shown to ameliorate the patient's quality of life and to enhance physical and psychological well-being. However, numerous patients are still obese when presenting for body contouring surgery, not able to lose additional weight for various reasons. Data regarding general feasibility, outcome, and postoperative complications in obese patients is rare. The aim of this study was to investigate the outcome in body contouring procedures in obese patients. A retrospective chart review of 65 cases in 42 patients was performed. Patients with a body mass index (BMI) > 35kg/m2 at the time of operation were enrolled and all different types of body contouring surgery were included. Complications were classified as major (need for surgical intervention) and minor complications. The median BMI of all patients was 38kg/m2 (range 35.1-65.1kg/m2). The majority of performed types of body contouring was abdominal body contouring (panniculectomy n = 27 (42%), abdominoplasty n = 12 (18%)). Complications occurred in 27 cases (41.5%). Twenty-one cases (32.3%) were classified as minor complications, six (9.2%) as major complications. The most common major complications were hematoma and wound dehiscence; the most common minor complication was seroma. A reasonable risk for complications is well known in body contouring surgery especially in obese patients. It is imperative to discuss related risks and expected results. Taking several points into account concerning the perioperative management, reduction of major complications is possible even in still obese patients, making body contouring surgery a discussible option.

Association of tourniquet utilization with blood loss, rehabilitation, and complications in Chinese obese patients undergoing total knee arthroplasty: A retrospective study.

Obesity not only gives rise to more blood loss volume but also correlates with postoperative rehabilitation and complications in surgical patients. It is not clear at present whether tourniquet utilization is associated with blood loss, rehabilitation, and complications, and it is imperative to ascertain the tactics of utilizing tourniquet in obese patients undergoing total knee arthroplasty (TKA). The present study was designed to explore the association of tourniquet utilization with blood loss, rehabilitation, and complications, and ascertain the tactics of utilizing tourniquet in obese patients undergoing TKA.A total of 130 patients from January 2014 to December 2014 were categorized into tourniquet group (n = 94) and non-tourniquet group (n = 36) based on whether the tourniquet was utilized or not during operation. Recorded data were as follows: total blood loss volume, intraoperative blood loss volume, hidden blood loss volume, blood transfusion volume, drainage volume, difference between hemoglobin value before operation and that on the fifth day after operation (5d Hb D-value), thigh swelling rate and visual analogue scale (VAS) score of motion pain, and Knee Society Score (KSS) score.Mean age was 65.27 ± 7.43 (49–82) years, and 15 patients (11.5%) were men. No significant difference in total blood loss volume, drainage volume, blood transfusion volume, and 5d Hb D-value was noted between the 2 groups (P > .05 for all). Tourniquet group had significantly less intraoperative blood loss volume and significantly more hidden blood loss volume than the non-tourniquet group (P < .05 for all). Tourniquet group had significantly higher thigh swelling rate and VAS score of motion pain on the third day after operation, and significantly lower KSS function score in the third week after operation than non-tourniquet group (P < .05). No significant difference in KSS function score in the first year after operation was found between the 2 groups (P > .05). No difference in postoperative complications was observed between the groups (P > .05).The current study demonstrated that the tourniquet is not associated with reduced blood loss and increased postoperative complications in obese patients undergoing TKA. Step-down postoperative rehabilitation related to tourniquet is short-term rather than long-term in obese patients undergoing TKA.

Stability of peritoneal tissue evaluated by the means of DSC in obese patients undergoing laparoscopic cholecystectomy

Obesity is considered to be the leading metabolic disease in the world. The coincidence of postoperative complications is higher in obese individuals; thus, laparoscopic techniques due to their minimally invasive character became a standard in the surgical treatment of obesity. The proper function of peritoneal tissue is essential for the response to surgical trauma. Therefore, understanding the alterations of peritoneal tissue of obese individuals might explain the increased number of postoperative complications observed in obese patients. The study aimed to assess whether the stability of peritoneum is altered in obese patients and whether it corresponds to early postoperative complications in obese patients. Samples of parietal peritoneal tissue were collected at the beginning of the laparoscopic cholecystectomy from 80 patients. Differential scanning calorimetry was performed on samples defrosted at room temperature. Patients were divided into three groups according to the BMI value. For statistical analysis, ANOVA, Chi-square, Student’s t test, and correlations with Pearson test were used. Significantly lower ΔH and higher Tm were in patients in whom intraperitoneal adhesions were reported. Lower ΔH was reported in samples obtained from patients with temperature above 37 °C in the first 24 h postoperatively. Enthalpy of thermal transition (ΔH) in peritoneum obtained from parous was significantly lower in comparison with the samples from nullipara. It can be concluded that DSC parameters correlated with parameters related to the early postoperative period. Occurrence of adhesions was reported more frequently in the group of obese and overweight individuals and correlated with lower change in enthalpy of collagen denaturation.

Associated Risks of Obesity and/or Metabolic Syndrome with Intra-operative or Post-Operative Occurrences in Patients with Open Ventral Hernia Repair

Metabolic syndrome and obesity are increasing in incidence worldwide and they carry with them a lot of health issues that might directly affect individuals or might be associated with higher risk of surgical complications represented in this study by open ventral hernia repair. A cohort study of 132 patients admitted electively for open ventral hernia repair to the surgical wards at Al-Sader teaching hospital in Najaf /Iraq from December 1st/ 2015 to October 1st/ 2016. All patients were followed for intra-operative occurrences and followed for 2 weeks postoperatively for any early post-operative complications. Of the total 132 patients, there were 44 patients (33.3%) having metabolic syndrome and there were 68 obese patients (66.6%) of which 37 having metabolic syndrome (54.4%). There was no significant association between intra-operative occurrences or early post-operative complications in obese patients with or without metabolic syndrome but there was a significant association between intra-operative occurrences and metabolic syndrome in patients having body mass index (BMI) below 30 Kg/m2. Diabetes was the only significant factor for early postoperative wound complications whether the patient had metabolic syndrome or not.

Impact of reduction mammoplasty on the quality of life of obese patients suffering from symptomatic macromastia: A descriptive cohort study

Although reduction mammoplasty (RM) is an effective and efficient treatment for symptomatic macromastia, overweight and obese patients who request this treatment are frequently rejected because of selection criteria based on the body mass index. Scientific evidence is inconclusive regarding the increased postoperative complications in obese patients undergoing RM, and there is a lack of adequately designed studies examining the impact of RM on the quality of life of this group of patients. A descriptive cohort study was performed on 37 consecutive obese patients (body mass index>30kg/m(2)) undergoing bilateral RM for symptomatic macromastia. Short Form SF-36 quality-of-life questionnaires were completed at interviews a week before surgery and 6 and 18 months after surgery. In addition, 37 women of matching ages, who were companions of patients hospitalized at our short-stay surgery unit, were used as a control group for comparison. Significant differences between repeated measurements on a single sample were assessed using the Wilcoxon signed-rank test. To evaluate these changes, we used effect size by computing Hedges' g corrected. The preoperative SF-36 physical component score was significantly lower than the control group's score (40 vs. 53, p<0.001). There was no significant difference in the mental component score (45 vs. 49, p=0.210). Postoperative SF-36 scores were increased with a normalizing effect, as 18 months after surgery only the body pain domain scored lower than the control group scores. According to our results, obese women with symptomatic macromastia undergoing RM exhibited increased quality of life, and this improvement was maintained over time. Level III Evidence.

Obesity Surgery Mortality Risk Score: Can we Go Beyond Mortality Prediction?

Introduction: High morbidity and low mortality has been linked to bariatric surgery. The Obesity surgery mortality risk score (OS-MRS) is a validated scale for mortality risk assessment. The aim of this study was to evaluate if OSMRS scale can also be used as a predictor of postoperative complications in obese patients submitted to primary laparoscopic gastric bypass. Methods: Retrospective study including all patients submitted to primary laparoscopic gastric bypass between January and December 2014. The OS-MRS scale was applied preoperatively, and postoperative to access morbidity and mortality at 30 and 90 days. Complications were classified according to Clavien-Dindo’s grades (I to V). The association between different OSMRS classes and the occurrence of adverse events was analyzed. Results: 85 patients were included and classified as class A (n=33; 38.8%), class B (n=48; 56.5%) and class C (n=4; 4.7%). No mortality cases were registered. The morbidity rate at 30 days was 23.5% (n=20), and 25.9% at 90 days (n=22). The complications rate in each of OS-MRS subgroups, was 9.1% in class A (both at 30 and 90 days), 31.3% and 35.4% in class B (at 30 and 90 days respectively), and 50% in class C (both at 30 and 90 days). There was a statistically significant independent relationship between OS-MRS scale, ASA physical status and the risk of developing pulmonary embolism, both at 30 and 90 postoperative days. Patients from classes B and C showed a greater risk of complications when compared to class A (at 30 days, OR 4.9, 95% IC: 1.3-18.2; p=0.019 and at 90 days, OR 5.8, 95% IC: 1.5-21.4; p=0.009). Conclusion: There is increasing evidence that OS-MRS scale is a useful tool to predict morbidity after gastric laparoscopic bypass in morbidly obese patients.

Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients

Background: Obese patients are at a high risk of postoperative complication, including surgical site infection (SSI). Our aim was to evaluate the effect of a high inspiratory oxygen fraction (80%) on SSI and pulmonary complications in obese patients undergoing laparotomy. Methods: This study was a planned analysis of the obese patients (body mass index 30 kg/m 2 ) recruited in the Danish multicenter, patient- and observer-blinded, PROXI Trial of 1,400 patients undergoing acute or elective laparotomy.Patientswererandomizedtoreceiveeither80%or30% oxygen during and for 2 h after surgery. The primary outcome was SSI within 14 days. Secondary outcomes were atelectasis, pneumonia, and respiratory failure. Results: Two hundred thirteen patients had a body mass index 30 kg/m 2 . The median (5–95% range) body mass index was 34 kg/m 2 (30–44) and 33 kg/m 2 (30–41) in patients allocated to the 80% and 30% oxygen group. SSI occurred in 32 of 102 (31%)versus29 of 111 (26%) patients given 80% and 30% oxygen, respectively (odds ratio, 1.29; 95%CI,0.71–2.34;P0.40).Inaddition,theincidenceof pulmonary complications was not significantly different, with atelectasis occurring in 9% versus 6%, pneumonia in 6% versus 5%, and respiratory failure in 8% versus 5% in patients given 80% and 30% oxygen, respectively. Conclusion: Administration of 80% oxygen, compared with 30% oxygen, did not reduce the frequency of SSI in obese patients. Moreover, no significant association was found between oxygen fraction and the risk of pulmonary complications.

Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients

Obese patients are at a high risk of postoperative complication, including surgical site infection (SSI). Our aim was to evaluate the effect of a high inspiratory oxygen fraction (80%) on SSI and pulmonary complications in obese patients undergoing laparotomy. This study was a planned analysis of the obese patients (body mass index ≥ 30 kg/m²) recruited in the Danish multicenter, patient- and observer-blinded, PROXI Trial of 1,400 patients undergoing acute or elective laparotomy. Patients were randomized to receive either 80% or 30% oxygen during and for 2 h after surgery. The primary outcome was SSI within 14 days. Secondary outcomes were atelectasis, pneumonia, and respiratory failure. Two hundred thirteen patients had a body mass index ≥ 30 kg/m². The median (5-95% range) body mass index was 34 kg/m² (30-44) and 33 kg/m² (30-41) in patients allocated to the 80% and 30% oxygen group. SSI occurred in 32 of 102 (31%) versus 29 of 111 (26%) patients given 80% and 30% oxygen, respectively (odds ratio, 1.29; 95% CI, 0.71-2.34; P = 0.40). In addition, the incidence of pulmonary complications was not significantly different, with atelectasis occurring in 9% versus 6%, pneumonia in 6% versus 5%, and respiratory failure in 8% versus 5% in patients given 80% and 30% oxygen, respectively. Administration of 80% oxygen, compared with 30% oxygen, did not reduce the frequency of SSI in obese patients. Moreover, no significant association was found between oxygen fraction and the risk of pulmonary complications.

Body mass index and the risk of postoperative complications with dentoalveolar surgery: A prospective study

Obesity is a disease that affects millions of Americans. Sixty-nine million Americans are considered to be overweight including at least 1 in 5 children. Overweight and obesity as risk factors for complications associated with dentoalveolar surgery have not been extensively studied. The purpose of this study was to prospectively investigate the frequency and the nature of postoperative complications in obese patients receiving ambulatory dentoalveolar surgery. Patients undergoing dentoalveolar outpatient ambulatory surgery at the University of Cincinnati Oral and Maxillofacial Surgery Clinic from January 10, 2005 to December 7, 2005 were enrolled in a prospective study. At the preoperative visit, height, weight, and age were recorded. The body mass index (BMI) was calculated and patients were divided into weight categories based on CDC and WHO classifications. Unfavorable outcomes studied included number of postoperative visits, infections, alveolar osteitis, soft and hard tissue problems, and postoperative bleeding. Complication categories were created for all complications identified during postoperative exams and t tests were performed to see if increased BMI correlated to higher postoperative complication rates, if multiple complications correlated to increased BMI, and to see if individual postoperative complication groups and BMI correlated. Because it was thought that complications would increase the number of postoperative exams for a particular patient, simple linear regression was used to see if BMI correlated to increased number of postoperative visits. No significant differences were noted in number of postoperative complications when comparing patients' BMIs (t = -0.62, P = .5350). Simple linear regression analysis showed that increased BMI did not predict increased number of postoperative visits. Increased age was the only predictor of increased postoperative complication risk (t = -3.17, P = .0016) and of increased number of postoperative visits (t = -16.35, P < .0001, and P < .0001 by nonparametric Wilcoxon rank sum test). The BMI is not statistically correlated to higher postoperative complication rates or increased number of postoperative visits. Obesity remains an important risk factor for dentoalveolar ambulatory outpatient anesthesia; however, it is not associated with poorer postoperative complication rates.