The effect of body mass index on the risk of surgical site infection

2019 ◽  
Vol 40 (9) ◽  
pp. 991-996 ◽  
Author(s):  
Anouk P. Meijs ◽  
Mayke B.G. Koek ◽  
Margreet C. Vos ◽  
Suzanne E. Geerlings ◽  
H. Charles Vogely ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Surgical Site Infection ◽  
Body Mass ◽  
Surgical Procedures ◽  
Hip Prosthesis ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Site Infection ◽  
Total Hip Prosthesis

AbstractObjective:Obesity is considered a risk factor for surgical site infection (SSI). We quantified impact of body mass index (BMI) on the risk of SSI for a variety of surgical procedures.Methods:We included 2012–2017 data from the Dutch national surveillance network PREZIES on a selection of frequently performed surgical procedures across different specialties. Patients were stratified into 5 categories: underweight (BMI, <18.5 kg/m2), normal weight (BMI, 18.5–25), overweight (BMI, 25–30), obese (BMI, 30–40) and morbidly obese (BMI, ≥40). Multilevel log binomial regression analyses were performed to assess the effect of BMI category on the risk of superficial, deep (including organ-space) and total SSI.Results:Of the 387,919 included patients (ranging from 2,616 for laparoscopic appendectomy to 119,834 for total hip prosthesis), 3,676 (1%) were underweight, 116,778 (30%) had normal weight, 154,339 (40%) were overweight, 104,288 (27%) had obesity, and 8,838 (2%) were morbidly obese. A trend of increasing risk of SSI when BMI increased from normal to morbidly obese was observed for almost all surgery types. The increase was most profound in surgeries with clean wounds, with relative risks for morbidly obese patients ranging up to 7.8 (95% CI, 6.0–10.2) for deep SSI in total hip prosthesis. In chest and abdominal surgeries, the impact was larger for superficial SSI than for deep SSI.Conclusions:The results of our research provide evidence for the need of preventive programs targeting SSI in overweight and obese patients, as well as for the prevention of obesity in the general population.

Appendicitis, Body Mass Index, and CT: Is CT More Valuable for Obese Patients than Thin Patients?

2011 ◽  
Vol 77 (4) ◽  
pp. 471-475 ◽  
Author(s):  
Courtney A. Coursey ◽  
Rendon C. Nelson ◽  
Ricardo D. Moreno ◽  
Mayur B. Patel ◽  
Craig A. Beam ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Negative Appendectomy ◽  
Obese Patients ◽  
Procedure Code ◽  
Preoperative Ct ◽  
The Difference ◽  
Underweight Patients

The purpose of our study is to determine whether body mass index (BMI = weight in kg/height in meters2) was related to the rate of negative appendectomy in patients who underwent preoperative CT. A surgical database search performed using the procedure code for appendectomy identified 925 patients at least 18 years of age who underwent urgent appendectomy between January 1998 and September 2007. BMI was computed for the 703 of these 925 patients for whom height and weight information was available. Patients were stratified based on body mass index (BMI 15-18.49 = underweight; 18.5-24.9 = normal weight; 25–29.9 = overweight; 30-39.9 = obese; > 40 = morbidly obese). Negative appendectomy rates were computed. Negative appendectomy rates for patients who did and did not undergo preoperative CT were 27 per cent and 50 per cent for underweight patients, 10 per cent and 15 per cent for normal weight patients, 12 per cent and 17 per cent for overweight patients, 7 per cent and 30 per cent for obese patients, and 10 per cent and 100 per cent for morbidly obese patients. The difference in negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT as compared with patients in the same BMI category who did not undergo preoperative CT was statistically significant ( P ≤ 0.001). The negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT were significantly lower than for patients in these same BMI categories who did not undergo preoperative CT.

Clinical Outcomes of Weight-Based Norepinephrine Dosing in Underweight and Morbidly Obese Patients: A Propensity-Matched Analysis

2018 ◽  
Vol 35 (6) ◽  
pp. 554-561 ◽  
Author(s):  
Aditya A. Kotecha ◽  
Saraschandra Vallabhajosyula ◽  
Dinesh R. Apala ◽  
Erin Frazee ◽  
Vivek N. Iyer
Keyword(s):  
Body Mass Index ◽  
Septic Shock ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Body Mass ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Obese Patients

Background: Weight-based dosing strategy for norepinephrine in septic shock patients with extremes of body mass index has been lesser studied. Methods: This historical study of adult septic shock patients was conducted from January 1, 2010, to December 31, 2015, at all intensive care units (ICUs) in Mayo Clinic, Rochester. Patients with documented body mass index were classified into underweight (body mass index <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), and morbidly obese (≥40 kg/m2) patients. Patients with repeat ICU admissions, ICU stay <1 day, and body mass index 25 to 39.9 kg/m2 were excluded. The primary outcome was in-hospital mortality, and secondary outcomes included cumulative norepinephrine exposure acute kidney injury, cardiac arrhythmias, and 1-year mortality. Two-tailed P < .05 was considered statistically significant. Results: From 2010 to 2015, 2016 patients met inclusion—145, 1406, and 466 patients, respectively, in underweight, normal weight, and morbidly obese cohorts. Underweight patients used the highest peak dose and absolute exposure was greatest for morbidly obese patients. In-hospital mortality decreased with increasing log10 body mass index: 41.4% (underweight), 28.4% (normal weight), and 24.7% (morbidly obese), respectively ( P < .001); however, this relationship was not noted at 1 year. Unadjusted log10 norepinephrine cumulative exposure (mg) was associated with higher in-hospital mortality, acute kidney injury, cardiac arrhythmias, and 1-year mortality. After adjustment for demographics, body mass index, comorbidity, and illness severity, log10 norepinephrine exposure was an independent predictor of in-hospital mortality (odds ratio 2.4 [95% confidence interval, 2.0-2.8]; P < .001) and 1-year mortality (odds ratio 1.7 [95% confidence interval, 1.5-2.0]; P < .001). In a propensity-matched analysis of 1140 patients, log10 norepinephrine was an independent predictor of in-hospital mortality (odds ratio 2.2 [95% confidence interval, 1.8-2.6]; P < .001). Conclusions: Morbidly obese patients had lower in-hospital mortality but had higher 1-year mortality compared to normal weight and underweight patients. Cumulative norepinephrine exposure was highest in morbidly obese patients. Total norepinephrine exposure was an independent mortality predictor in septic shock.

Morbid Obesity does not Increase Morbidity or Mortality in Robotic Cardiac Surgery

2017 ◽  
Vol 12 (6) ◽  
pp. 434-439 ◽  
Author(s):  
Hiroto Kitahara ◽  
Brooke Patel ◽  
Mackenzie McCrorey ◽  
Sarah Nisivaco ◽  
Husam H. Balkhy
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Cardiac Surgery ◽  
Body Mass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Robotic Cardiac Surgery

Objective Morbid obesity (body mass index S 35 kg/m2)usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients. Methods We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients. Results A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years). The robotic procedures were the following: totally endoscopic beating heart coronary artery bypass (n = 263), mitral valve surgery (n = 138), arrhythmia surgery (n = 33), adult congenital surgery (n = 16), pericardiectomy (n = 11), and others (n = 25). The cohorts were divided into the following: normal weight (body mass index < 25, n = 123), overweight (body mass index = 25 to < 30, n = 182), obesity (body mass index = 30 to < 35, n = 105), and morbid obesity (body mass index S 35, n = 76). Morbidly obese patients had a higher rate of hypertension, dyslipidemia, and diabetes mellitus compared with normal or overweight patients. There were no significant differences in morbidity, mean length of intensive care unit stay (2.10 ± 4.27 days), and hospital stay (4.48 ± 5.61 days) among the groups. In-hospital mortality was 1.4% (7/486) with nonsignificant difference. Conclusions Outcomes of robotic heart surgery in morbidly obese patients in our center were acceptable. Over a broad range of cardiac surgical procedures, morbid obesity was not associated with increased morbidity or mortality when these procedures were performed using a robotic approach. These findings can be beneficial in managing this challenging group of patients.

Performance of Target-controlled Sufentanil Infusion in Obese Patients

2003 ◽  
Vol 98 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Gregory Slepchenko ◽  
Nicolas Simon ◽  
Bernard Goubaux ◽  
Jean-Claude Levron ◽  
Jean-Pierre Le Moing ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Volume Of Distribution ◽  
Normal Weight ◽  
Pharmacokinetic Analysis ◽  
Pharmacokinetic Parameters ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Mixed Effect ◽  
Performance Error

Background Because obesity might affect pharmacokinetic parameters, the authors evaluated the accuracy of target-controlled sufentanil infusion in morbidly obese patients using a pharmacokinetic model usually applied to a normal-weight population. Methods Target-controlled propofol and sufentanil coinfusions were administered to 11 morbidly obese patients (body mass index: 45.0 +/- 6.5 kg/m2 ) undergoing laparoscopic gastroplasty. The target plasma propofol concentration was 3 micro g/ml. The effect-site sufentanil target concentration was initially 0.4 ng/ml but was modified during surgery as a function of blood pressure and heart rate. Plasma sufentanil concentrations were measured from the onset of infusion until 24 h after its termination. The predicted sufentanil target concentrations were calculated by STANPUMP software. Intrasubject data analyzed included calculation of performance error, median performance error, median absolute performance error, divergence, and wobble. Pharmacokinetic analysis was performed using a nonlinear mixed effect model. Results Applied sufentanil target concentrations ranged from 0.3 to 0.65 ng/ml. The mean +/- SD plasma sufentanil concentration measured during spontaneous ventilation was 0.13 +/- 0.03 ng/ml. Median performance error (range) was -13% (-42 to 36%). Median absolute performance error was 26% (8-44%) during infusion and 17% (12-59%) for the 24 h after its completion. The pharmacokinetic sets used slightly overpredicted the concentrations, with a median divergence of -3.4% (-10.2 to 3.1%) during infusion. For body mass index greater than 40, the overestimation of plasma sufentanil concentrations was greater. A two-compartment model with proportional error for interindividual variability best fitted the data. The residual variability was modeled as an additive (0.016 ng/ml) or proportional error (23%). Clearance, central volume of distribution, intercompartmental clearance, and peripheral volume of distribution (coefficient of variation) were 1.27 l/min (23%), 37.1 l (20%), 0.87 l/min (44%), and 92.7 l (22%), respectively. Conclusion The pharmacokinetic parameter set derived from a normal-weight population accurately predicted plasma sufentanil concentrations in morbidly obese patients.

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

The Influence of Body Mass Index in Obese and Morbidly Obese Patients on Complications and 30- and 90-day Readmissions Following Lumbar Spine Fusion

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Xiao T. Chen ◽  
Shane Shahrestani ◽  
Alexander M. Ballatori ◽  
Andy Ton ◽  
Zorica Buser ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Lumbar Spine ◽  
Body Mass ◽  
Spine Fusion ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Lumbar Spine Fusion

Recategorisation of body mass index to achieve andrological predictive power: a study in more than 20 000 patients

2020 ◽  
Vol 32 (7) ◽  
pp. 648 ◽  
Author(s):  
Nicolás Ramírez ◽  
Rosa Inés Molina ◽  
Andrea Tissera ◽  
Eugenia Mercedes Luque ◽  
Pedro Javier Torres ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Analysis Of Variance ◽  
Predictive Power ◽  
Linear Models ◽  
Semen Quality ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Chi Squared ◽  
Underweight Patients

The aim of this study was to recategorise body mass index (BMI) in order to classify patients according to their risk of semen abnormalities. Patients (n=20563) presenting at an andrology laboratory were classified into five groups according to BMI: underweight (BMI &lt;20kg m−2), normal weight (BMI 20–24.9kg m−2), overweight (BMI 25–29.9kg m−2), obese (BMI 30–39.9kg m−2) and morbidly obese (BMI &gt;40kg m−2). Semen quality was evaluated to determine: (1) differences between groups using analysis of variance (ANOVA); (2) the chances of semen abnormalities (using generalised linear models, Chi-squared tests and odds ratios); (3) reference BMI values with andrological predictive power (multivariate conglomerate analyses and multivariate analysis of variance (MANOVA)); and (4) expected values of abnormalities for each new group resulting from BMI recategorisation. Morbidly obese and underweight patients exhibited the highest decrease in semen quality and had higher chances of semen abnormalities. The smallest number of sperm abnormalities was found at a BMI of 27kg m−2. Four reference values were identified, recategorising BMI into four groups according to their risk of semen abnormalities (from lowest to highest risk): Group1,BMI between 20 and 32kg m−2; Group2, BMI &lt;20 and BMI &gt;32–37kg m−2; Group3, BMI &gt;37–42kg m−2; and Group4, BMI &gt;42kg m−2. A BMI &lt;20 or &gt;32kg m−2 is negatively associated with semen quality; these negative associations on semen quality increase from a BMI &gt;37kg m−2 and increase even further for BMI &gt;42kg m−2. The BMI recategorisation in this study has andrological predictive power.

Positive End-expiratory Pressure Improves Respiratory Function in Obese but not in Normal Subjects during Anesthesia and Paralysis 

1999 ◽  
Vol 91 (5) ◽  
pp. 1221-1221 ◽  
Author(s):  
Paolo Pelosi ◽  
Irene Ravagnan ◽  
Gabriella Giurati ◽  
Mauro Panigada ◽  
Nicola Bottino ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Chest Wall ◽  
Body Mass ◽  
Respiratory System ◽  
Respiratory Function ◽  
Normal Subjects ◽  
Intraabdominal Pressure ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Positive End Expiratory Pressure

Background Morbidly obese patients, during anesthesia and paralysis, experience more severe impairment of respiratory mechanics and gas exchange than normal subjects. The authors hypothesized that positive end-expiratory pressure (PEEP) induces different responses in normal subjects (n = 9; body mass index &lt; 25 kg/m2) versus obese patients (n = 9; body mass index &gt; 40 kg/m2). Methods The authors measured lung volumes (helium technique), the elastances of the respiratory system, lung, and chest wall, the pressure-volume curves (occlusion technique and esophageal balloon), and the intraabdominal pressure (intrabladder catheter) at PEEP 0 and 10 cm H2O in paralyzed, anesthetized postoperative patients in the intensive care unit or operating room after abdominal surgery. Results At PEEP 0 cm H2O, obese patients had lower lung volume (0.59 +/- 0.17 vs. 2.15 +/- 0.58 l [mean +/- SD], P &lt; 0.01); higher elastances of the respiratory system (26.8 +/- 4.2 vs. 16.4 +/- 3.6 cm H2O/l, P &lt; 0.01), lung (17.4 +/- 4.5 vs. 10.3 +/- 3.2 cm H2O/l, P &lt; 0.01), and chest wall (9.4 +/- 3.0 vs. 6.1 +/- 1.4 cm H2O/l, P &lt; 0.01); and higher intraabdominal pressure (18.8 +/-7.8 vs. 9.0 +/- 2.4 cm H2O, P &lt; 0.01) than normal subjects. The arterial oxygen tension was significantly lower (110 +/- 30 vs. 218 +/- 47 mmHg, P &lt; 0.01; inspired oxygen fraction = 50%), and the arterial carbon dioxide tension significantly higher (37.8 +/- 6.8 vs. 28.4 +/- 3.1, P &lt; 0.01) in obese patients compared with normal subjects. Increasing PEEP to 10 cm H2O significantly reduced elastances of the respiratory system, lung, and chest wall in obese patients but not in normal subjects. The pressure-volume curves were shifted upward and to the left in obese patients but were unchanged in normal subjects. The oxygenation increased with PEEP in obese patients (from 110 +/-30 to 130 +/- 28 mmHg, P &lt; 0.01) but was unchanged in normal subjects. The oxygenation changes were significantly correlated with alveolar recruitment (r = 0.81, P &lt; 0.01). Conclusions During anesthesia and paralysis, PEEP improves respiratory function in morbidly obese patients but not in normal subjects.

scholarly journals Cardiac Changes in Overweight and Obese Patients

2016 ◽  
Vol 54 (3) ◽  
pp. 161-172 ◽  
Author(s):  
Teodora Gabriela Alexescu ◽  
Angela Cozma ◽  
Adela Sitar-Tăut ◽  
V. Negrean ◽  
M.I. Handru ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Left Ventricle ◽  
Diastolic Dysfunction ◽  
Body Mass ◽  
Body Surface ◽  
Interventricular Septum ◽  
Normal Weight ◽  
The Body ◽  
Obese Patients ◽  
Left Ventricle Mass

Abstract Background. Obesity and overweight are two pathologies that are more and more frequent in the XXIst century diagnosis and are causing high morbidity and mortality rates in the general population, especially through cardiovascular complications.Aims. Identification and early diagnosis of cardiac changes in overweight and obese patients. Material and method. We carried out a sectional, analytical and observational study on 111 subjects: 27 normal weight subjects and 84 overweight and obese patients, which were submitted to a clinical exam, biochemical exams and 2D ultrasound.Results. The presence of diastolic dysfunction is twice more frequent in overweight patients in comparison to normal weight ones (30% vs 15%) and 5 times more frequent in obese patients than normal weight ones (75% vs 15%). The size increase of the interventricular septum is correlated with the body mass index, there being statistically significant differences between normal weight vs overweight vs obese patients, as well as between overweight and obese ones. Within the whole group and within the groups, both the left ventricle mass (g) as well as the left ventricle mass to body surface ratio (g/m²) are statistically significantly higher in patients with present diastolic dysfunction (E/A < 1). This indicates a relation between the presence of diastolic dysfunction, increased left ventricle mass and body mass index (p < 0.05).Conclusions. Overweight and obese patients, unlike normal weight ones, present early cardiac changes, such as: a decrease of left ventricle ejection fraction, diastolic dysfunction, thickening of the interventricular septum, increase of the left ventricle mass both per se as well as in ratio to body surface.

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