scholarly journals Impact of body mass index on perioperative outcomes during the learning curve for robot-assisted radical prostatectomy

2013 ◽  
Vol 4 (4) ◽  
pp. 250 ◽  
Author(s):  
Venu Chalasani ◽  
Carlos H. Martinez ◽  
Darwin Lim ◽  
Reem Al Bareeq ◽  
Geoffrey R. Wignall ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Regression Analysis ◽  
Radical Prostatectomy ◽  
Learning Curve ◽  
Body Mass ◽  
Independent Predictor ◽  
Postoperative Outcomes ◽  
Obese Patients ◽  
Entire Cohort ◽  
Significant Difference

Introduction: Previous studies of robotic-assisted radical prostatectomy(RARP) have suggested that obesity is a risk factor for worseperioperative outcomes. We evaluated whether body mass index(BMI) adversely affected perioperative outcomes.Methods: A prospective database of 153 RARP (single surgeon)was analyzed. Obesity was defined as BMI ≥ 30 kg/m2; normalBMI < 25 kg/m2; and overweight as 25 to 30 kg/m2. Two separateanalyses were performed: the first 50 cases (the initial learningcurve) and the entire cohort of 153 RARP.Results: In the initial cohort of 50 cases (14 obese patients), therewas no statistically significant difference with regards to operativetimes, port-placement times and estimated blood loss (EBL). Lengthof stay (LOS) was longer in the obese group (4.3 vs. 2.9 days); BMIremained an independent predictor of increased LOS on multivariatelinear regression analysis (p = 0.002). There was no statisticallysignificant difference in the postoperative outcomes of leak rates,margin rates and incisional herniae. In the entire cohort, whencomparing obese patients to those with a normal BMI, there wasno statistically significant difference in operative times, EBL, LOS,or immediate postoperative outcomes. However, on multivariatelinear regression analysis, BMI was an independent predictor ofincreased operative time (p = 0.007).Conclusion: Obese patients do not have an increased risk of bloodloss, positive margins or the postoperative complications of incisionalhernia and leak during the learning curve. They do, however,have slightly longer operative times; we also noted an increasedLOS in our first 50 cases.Introduction : Des études antérieures sur la prostatectomie radicaleassistée par robot (PRAR) ont laissé entendre que l’obésité était unfacteur de risque de complications périopératoires. Nous avonsévalué si l’indice de masse corporelle (IMC) affectait de façonnégative les résultats de l’opération.Méthodologie : Une base de données prospective comptant153 PRAR (effectuées par un seul chirurgien) a été analysée. On adéfini l’obésité comme un IMC ≥ 30 kg/m2, un IMC normal étant< 25 kg/m2, et un IMC entre 25 et 30 kg/m2 représentant un surplusde poids. Deux analyses distinctes ont été réalisées : les 50 premierscas (courbe d’apprentissage initiale) et la cohorte entière des153 patients ayant subi une PRAR.Résultats : Dans la cohorte initiale de 50 cas (dont 14 patientsobèses), on n’a noté aucune différence significative sur le planstatistique en ce qui concerne la durée de l’opération, le tempsrequis pour installer l’accès vasculaire et la perte de sang approximative.La durée du séjour était plus longue dans le groupe despatients obèses (4,3 contre 2,9 jours), et l’IMC est demeuré unfacteur indépendant de prédiction d’une durée prolongée du séjourlors de l’analyse de régression linéaire multivariée (p = 0,002).Aucune différence significative sur le plan statistique n’a été notéedans les résultats postopératoires quant aux taux de fuite, aux tauxde marges positives et aux hernies incisionnelles. Dans toute lacohorte, on n’a noté aucune différence significative sur le planstatistique entre les patients obèses et les patients dont l’IMC étaitnormal en ce qui a trait à la durée de l’opération, la perte desang, la durée du séjour et les résultats postopératoires immédiats.Néanmoins, l’IMC s’est révélé un facteur de prédiction indépendantd’une durée prolongée de l’opération lors de l’analyse de régressionlinéaire multivariée (p = 0,007).Conclusion : Les patients obèses ne courent pas un risque plus élevéde perte de sang, de marges positives ou de complications postopératoirescomme une hernie incisionnelle ou une fuite pendantla période de la courbe d’apprentissage du chirurgien. Ils nécessitenttoutefois une opération légèrement plus longue; une duréeplus longue du séjour a aussi été notée chez les 50 premiers cas.

Serum myonectin is increased after laparoscopic sleeve gastrectomy

2020 ◽  
Vol 57 (5) ◽  
pp. 360-364
Author(s):  
Lei Li ◽  
Qianqian Wang ◽  
Chengkun Qin
Keyword(s):  
Body Mass Index ◽  
Regression Analysis ◽  
Sleeve Gastrectomy ◽  
Linear Regression ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Body Mass ◽  
Linear Regression Analysis ◽  
Acid Uptake ◽  
Model Assessment ◽  
Obese Patients

Objective Myonectin, a newly discovered myokine, enhances fatty acid uptake in cultured adipocytes and hepatocytes and suppresses circulating levels of free fatty acids in mice. Recent studies showed that serum myonectin concentration is negatively correlated with obesity. This study was undertaken to evaluate the change of serum myonectin in obese patients after laparoscopic sleeve gastrectomy. Methods This study was performed in a population of 42 obese and 58 control subjects from April of 2018 to December of 2019. All obese subjects underwent laparoscopic sleeve gastrectomy. Anthropometric measurements, lipid profiles, HbA1c and serum myonectin were assessed at baseline and six months after laparoscopic sleeve gastrectomy. Results Serum myonectin concentrations were significantly lower in the obese patients than in the controls. Serum myonectin concentrations were increased at six months after laparoscopic sleeve gastrectomy. Simple linear regression analysis indicated that serum myonectin was negatively correlated with weight, waist circumference, hip circumference, body mass index, fasting plasma glucose, homeostasis model assessment of insulin resistance and HbA1c. Only body mass index was still inversely correlated with serum myonectin after multiple linear regression analysis. Conclusion Serum myonectin is correlated with obesity and increased after laparoscopic sleeve gastrectomy.

scholarly journals TRAUMATIC DISEASE PECULIARITIES COURSE, ITS DIAGNOSTICS AND TREATMENT AT POLYTRAUMA IN SUFFER OBESE PATIENTS

2019 ◽  
Vol 43 (4) ◽  
pp. 47-53
Author(s):  
S.D. Khimich ◽  
O. M. Chemerys
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Overweight And Obesity ◽  
The Body ◽  
Obese Patients ◽  
Prognostic Features ◽  
Normal Body ◽  
Significant Difference ◽  
Normal Body Weight

Abstract Introduction. It’s known that the issue of polytrauma is one of the most urgent problems of surgery, and among injured patients a special approach is required for patients with overweight and obesity of varying degrees. Purpose of the study. To study prognostic features of traumatic disease course and to improve the results of diagnostics and surgical treatment of patients with polytrauma suffer obesity. Materials and methods. Clinical material was made up of 106 patients with combined body trauma, which were divided into three groups according to body mass index. Results. The results of the research showed a significant difference in the course of traumatic disease in patients with normal body weight and obesity. In particular, in the process of diagnostics of blunt chest and abdominal trauma the frequency of application of interventional methods of diagnostics was directly proportional to the increase of body mass index. The course of traumatic disease in the obese patients had a number of characteristic features that formed the basis for the development of diagnostics and differential program of treatment. Conclusions. The results of the research showed that the course of traumatic disease in combined injury obese patients is directly proportional to the body mass index and has certain features that differentiate them from patients with normal body weight. Keywords: polytrauma, obesity, traumatic disease, diagnostics, treatment.

460: Increasing Body Mass Index is not an Independent Predictor of Outcome Following Radical Prostatectomy

2007 ◽  
Vol 177 (4S) ◽  
pp. 154-154
Author(s):  
Piruz Motamedinia ◽  
Ruslan Korets ◽  
Benjamin A. Spencer ◽  
Mitchell C. Benson ◽  
James M. McKiernan
Keyword(s):  
Body Mass Index ◽  
Radical Prostatectomy ◽  
Body Mass ◽  
Independent Predictor

Pattern of chemotherapy dosing in obese patients in a community hospital.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13099-e13099
Author(s):  
Malar Thwin ◽  
Aye Min Soe ◽  
Nay Min Tun ◽  
Gina M. Villani
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Dose Adjustment ◽  
Drug Exposure ◽  
Obese Patients ◽  
Chi Square ◽  
Full Dose ◽  
Reduced Dose ◽  
Significant Difference ◽  
Chemotherapy Dose

e13099 Background: Obesity has increased to epidemic proportions, with 32.2% of US adults aged 20 years or older classified as obese (body mass index ≥ 30 mg/m2). In view of altered pharmacokinetics and possible excessive toxicity in obese patients, chemotherapy dose reductions are often employed in treating obese cancer patients. To our knowledge, there are no reports in the literature identifying patients who should have empiric dose adjustment because of obesity or the best method of dosing chemotherapy to standardize drug exposure in patients with varying degrees of obesity. As practice varies among institutions, we carried out a retrospective study to evaluate the chemotherapy dosing pattern in our obese patient population. Methods: Charts of patients who received chemotherapy at our institution during the year 2010 were reviewed. Data on age, height, weight, type and stage of cancer, date of chemotherapy, and type and dose of chemotherapy were retrieved from chart review. Only details of the first chemotherapy cycle at our institution were collected. Body surface area (BSA) was calculated by using the Mosteller formula. Independent samples t-test and Pearson chi-square statistics were used to investigate the difference between the means and proportions respectively. Results: Data from 191 patients were analyzed. Distributions (mean and range) of age, height, weight, body mass index (BMI) and BSA were 60 years (26 - 88), 65 inches (53 - 79), 166 pounds (90 - 340), 27.44 kg/m2 (14.52 - 56.57) and 1.85 m2 (1.36 - 2.66), respectively. Patients who had a full dose (n = 164) had a mean BMI of 27 kg/m2 (standard deviation (SD) 6.5) and a mean BSA of 1.82 m2 (SD 0.24) whereas those with a reduced dose had BMI (n = 27, mean 30.2, SD 7.1) and BSA (mean 1.97, SD 0.25). There is a significant difference between the means of the two groups (full dose and reduced dose) in terms of both BSA and BMI (p = 0.033 and p = 0.01, respectively). Significantly higher proportion of patients with BSA ≥ 2 received reduced dose compared to those with BSA < 2 (14 out of 48 (20.3%) versus 13 out of 143 (9%), p = 0.001). Conclusions: Patients with BSA ≥ 2 were more likely to get empiric chemotherapy dose adjustment at our institution. Further studies on chemotherapy dosing in obese patients are warranted.

Risk factors for development of obesity in an ethnically diverse CHD population

2019 ◽  
Vol 29 (2) ◽  
pp. 123-127
Author(s):  
Scott J. Weinreb ◽  
Abigail J. Pianelli ◽  
Sreyans R. Tanga ◽  
Ira A. Parness ◽  
Rajesh U. Shenoy
Keyword(s):  
Body Mass Index ◽  
Regression Analysis ◽  
Linear Regression ◽  
Longitudinal Data ◽  
Body Mass ◽  
Linear Regression Analysis ◽  
Paediatric Population ◽  
Post Surgery ◽  
Significant Difference ◽  
Age Cohort

AbstractObjectivesPrevious cross-sectional studies have demonstrated obesity rates in children with CHD and the general paediatric population. We reviewed longitudinal data to identify factors predisposing to the development of obesity in children, hypothesising that age may be an important risk factor for body mass index growth.Study designRetrospective electronic health records were reviewed in all 5–20-year-old CHD patients seen between 2011 and 2015, and in age-, sex-, and race/ethnicity-matched controls. Subjects were stratified into aged cohorts of 5–10, 11–15, and 15–20. Annualised change in body mass index percentile (BMI%) over this period was compared using paired Student’s t-test. Linear regression analysis was performed with the CHD population.ResultsA total of 223 CHD and 223 matched controls met the inclusion criteria for analysis. Prevalence of combined overweight/obesity did not differ significantly between the CHD cohort (24.6–25.8%) and matched controls (23.3–29.1%). Univariate analysis demonstrated a significant difference of BMI% change in the age cohort of 5–10 (CHD +4.1%/year, control +1.7%/year, p=0.04), in male sex (CHD +1.8%/year, control −0.3%/year, p=0.01), and status-post surgery (CHD 2.03%/year versus control 0.37%, p=0.02). Linear regression analysis within the CHD subgroup demonstrated that age 5–10 years (+4.80%/year, p<0.001) and status-post surgery (+3.11%/year, p=0.013) were associated with increased BMI% growth.ConclusionsPrevalence rates of overweight/obesity did not differ between children with CHD and general paediatric population over a 5-year period. Longitudinal data suggest that CHD patients in the age cohort 5–10 and status-post surgery may be at increased risk of BMI% growth relative to peers with structurally normal hearts.

scholarly journals Impact of body mass index on perioperative outcomes during the learning curve for robot assisted radical prostatectomy

2010 ◽  
Vol 4 (4) ◽  
pp. 250-254 ◽  
Author(s):  
Venu Chalasani ◽  
Carlos H. Martinez ◽  
Darwin Lim ◽  
Reem Al Bareeq, ◽  
Geoffrey R. Wignall ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Radical Prostatectomy ◽  
Learning Curve ◽  
Body Mass ◽  
Perioperative Outcomes ◽  
Robot Assisted

scholarly journals Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients

2018 ◽  
Vol 12 (8) ◽  
pp. 207-216 ◽  
Author(s):  
Katie B. Tellor ◽  
Steffany N. Nguyen ◽  
Amanda C. Bultas ◽  
Anastasia L. Armbruster ◽  
Nicholas A. Greenwald ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
International Normalized Ratio ◽  
Hospitalized Patients ◽  
Morbidly Obese ◽  
Weekly Dose ◽  
Obese Patients ◽  
Significant Difference ◽  
Underweight Patients ◽  
The Impact

Background: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI. Methods: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization). Exclusion criteria included: age under 18 years, pregnancy, INR (goal 2.5–3.5), and warfarin thromboprophylaxis post orthopedic surgery. The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI <18 kg/m2), normal/overweight (BMI 18–29.9 kg/m2), obese (BMI 30–39.9 kg/m2), and morbidly obese (BMI ⩾ 40 kg/m2). Data were extracted from two community hospitals in reverse chronologic order during July 2015–June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe. Results: A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance ( p < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, p = 0.035). Of those, there was a statistically significant difference in TWD ( p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017). Conclusions: Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.

Correlation of high body mass index and circulating tumor cell positivity in patients with early-stage breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1600-1600 ◽  
Author(s):  
Uta Ortmann ◽  
Wolfgang Janni ◽  
Ulrich Andergassen ◽  
Thomas Beck ◽  
Matthias W. Beckmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Early Breast Cancer ◽  
Early Stage ◽  
High Body Mass Index ◽  
Obese Patients ◽  
Cellsearch System ◽  
Significant Difference

1600^ Background: The prognostic relevance of both body mass index (BMI) and circulating tumor cells (CTC) has been confirmed in different trials for patients with early breast cancer. This analysis evaluates the correlation between high BMI and CTC positivity as risk factors for reduced disease free and overall survival. Methods: Data of 3658 patients of the SUCCESS A trial have been analyzed. CTC count and BMI were documented before (N = 2026) and after (N = 1504) chemotherapy. Within this trial patients with early breast cancer were randomized to two chemotherapy regimens and received either 3 cycles of fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel (FE100C-Doc) or 3 cycles of fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel and gemcitabine(FE100C-DG). In addition, patients were randomized to zoledronic acid either for 2 or 5 years. CTC were analyzed using the CellSearch System (Veridex, USA). Different groups of bodyweight were classified according to the WHO’s international definition: Underweight (BMI < 18,5 kg/m2), normal range (BMI > 18,5- < 25), overweight (BMI >25- < 30), obesity (BMI > 30). Correlation between CTC count and BMI was analyzed using frequency-table methods. Results: At study entry 24 (1.2%) patients were underweight, 952 (47%) patients were normal weight, 658 (32.5%) patients were overweight and 392 (19.4%) patients were obese. Before the start of chemotherapy, CTC were detected in 435 (21.5%) patients. We did not find a correlation between CTC positivity and BMI (p=0.94). After chemotherapy CTC were detected in 330 (16,3%) patients. Again, there was no statistically significant correlation between BMI and CTC positivity (p=0.86). In particular, CTC positivity was not observed more frequently in obese patients neither before (p=0.70) nor after chemotherapy (p=0.95) compared to patients with a BMI < 30 kg/m2. Conclusions: As compared to patients with normal BMI, there was no significant difference in the prevalence of CTC in underweight, overweight and obese patients, respectively, neither before nor after chemotherapy. The risk factors obesity and prevalence of CTC seem to be independent prognostic factors.

scholarly journals Arthroscopic anatomical reconstruction of the lateral collateral ankle ligament: an examination of the learning curve and the influence of laterality and body mass index

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0001
Author(s):  
Matthieu Courtine ◽  
Sébastien Tomes ◽  
François Molinier ◽  
Nicolas Cellier ◽  
Thomas Bauer
Keyword(s):  
Body Mass Index ◽  
Learning Curve ◽  
Body Mass ◽  
Ligament Reconstruction ◽  
Operating Time ◽  
Good Control ◽  
Anatomical Reconstruction ◽  
Gracilis Tendon ◽  
Ankle Ligament ◽  
Significant Difference

Objectives: Anatomical reconstruction under arthroscopy by gracilis tendon autograft is an innovative technique in full development and requires a learning curve. Our objective was to evaluate this curve and determine the influence of the surgical side and the patient’s body mass index (BMI) on the performance of the procedure. Methods: In this retrospective study, conducted from January 2015 to March 2020, data was collected from 7 centers through 11 operators, and included the surgical side, body mass index and total procedure time. The ankle ligament reconstruction had to be performed entirely under arthroscopy, without any associated procedure, at the expense of the gracilis tendon. The learning curve was calculated over the total operating time. Results: The learning curve showed a logarithmic pattern with an average decrease of 20% in operating time for the 4th patient. In the largest cohort, there was a significant difference in operating time between the right and left sides (35.39 minutes vs. 32.29 minutes, p < 0.002, [CI95] = 1.23; 4.98). In the two largest cohorts, there was a correlation between operating time and BMI (ρ= 0.7022, p < 7.29E-20, [CI95] = 0.6006; 0.7814 and ρ= 0.2749, p < 0.025, [CI95] = 0.0371; 0.4832) for all the patients (ρ= 0.1753, p < 0.0001, [CI95] = 0.0867; 0.2612). Conclusion: Arthroscopic anatomical ligament reconstruction of the ATFL and CFL is a technical intervention with a fast learning curve, with good control of the procedure in less than ten procedures. The surgical side and the patient’s BMI were noted to have an influence on the duration of the procedure.

scholarly journals Analysis of the applied technique of intravenous anesthesia for in vitro fertilization in obese and patients with normal body mass index

2019 ◽  
Vol 147 (9-10) ◽  
pp. 588-594
Author(s):  
Nebojsa Videnovic ◽  
Jovan Mladenovic ◽  
Aleksandar Pavlovic ◽  
Sladjana Trpkovic ◽  
Milan Filipovic ◽  
...  
Keyword(s):  
Body Mass Index ◽  
In Vitro Fertilization ◽  
Body Mass ◽  
Muscle Relaxation ◽  
Normal Body Mass Index ◽  
Obese Patients ◽  
Vitro Fertilization ◽  
Normal Body ◽  
Significant Difference

Introduction/Objective. In this study, the effects of applied anesthetic techniques were investigated in a retrospective analysis of obese patients and those with normal body mass index undergoing in vitro fertilization, using bispectral index as an indicator of anesthetic depth. Methods. In total 116 patients with normal body mass index were allocated to group N. Another 116 patients with body mass index > 30 kg/m2 were allocated to group O. Anesthetic protocol comprised midazolam for premedication, diclofenac for pre-emptive analgesia, propofol for induction and maintenance, alfentanil for analgesia, suxamethonium for muscle relaxation. We recorded and compared the monitored parameters using t-test and ?2 test. Results. Procedure duration and recovery time were significantly longer in O group (p < 0.01). There is a statistically significant difference (p = 0.000181) in the number of patients requiring mechanical ventilation after induction of anesthesia. Propofol consumption was significantly higher (p < 0.0001) in O group (2.7 ? 1.6 mg/kg) as compared to group N (2.1 ? 0.4 mg/kg). The incidence of postoperative nausea and vomiting was observed in six patients in N group (5.17%) and nine patients in O group (7.76%). Pain intensity was found higher in group O compared to group N (p < 0.0001). Assessment of patients? sedation using verbal scale reported no statistically significant difference between N and O groups (p = 0.2548). Conclusion. Induction and maintenance of anesthesia in obese patients results in increased consumption of propofol and the need for muscle relaxation. The statements of the patients who underwent the procedure under intravenous propofol and alfentanil serve as the best recommendation for clinical practice.

Sign in / Sign up

Export Citation Format

Share Document