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1.
Nagy Mekhail Diana Mehanny Sherif Armanyous Youssef Saweris Shrif Costandi 《The spine journal》2019,19(3):476-486
BACKGROUND CONTEXT
Chronic pain and obesity are both on the rise. Spinal cord stimulation has gained increasing popularity in the pain management field for the treatment of spine-related chronic pain, however to-date, the correlation between the spinal cord stimulator effectiveness and increasing body mass index (BMI) has not been fully established.PURPOSE
We aimed to investigate the correlation between patients’ BMI and the percentage of pain relief as well as opioid utilization in chronic spine-related pain patients treated with spinal cord stimulation.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Patients with chronic spine-related pain who were treated with a spinal cord stimulator.OUTCOME MEASURES
Eleven-point numeric rating scale for pain and opioid utilization.METHODS
Following Institutional Review Board approval, data from all eligible subjects who had undergone successful spinal cord stimulation (SCS)-trial defined as ≥50% decrease in pain followed by SCS implant were collected and statistically analyzed. Patients were divided into four groups according to BMI. Self-reported pain scores on the 11-point numerical rating scale were collected at baseline, 6 months and 12 months post SCS-implant visits. Opioid utilization, if any, was collected at baseline and 12 months post-SCS implant.RESULTS
In all, 181 patients were included. Thirty-three were under and/or normal weight (≤24.9 kg/m2), 72 overweight (25.0–29.9 kg/m2), 63 obese (30.0–39.9 kg/m2), and 13 morbidly obese (≥40.0 kg/m2). The estimated coefficients from multivariable linear regression analysis were ?1.91% (95% CI: ?2.82% to ?0.991%) and ?1.48% (95% CI: ?2.30% to ?0.660%) reduction in pain improvement per unit increase of BMI for 6 months and 12 months scores, respectively. The estimated coefficient of disability status was ?15.3% (95% CI: ?22.1% to ?8.48%). The estimated coefficient for 12 month opioid equivalence was ?0.08% (95% CI: ?0.14 to ?0.021), per` 1 mg unit increase of morphine opioid equivalency. The data showed a statistically significant negative association between increasing BMI and SCS effectiveness at 6 and 12 months post-SCS therapy with a 2% reduction in efficacy for every unit increase of BMI after adjusting for confounding factors and a 20% better response in underweight and/or normal patients over the morbidly obese individuals which was not related to baseline pain score level. The significant difference in pain scores at 6 months (p = .0003) and 12 months (p = .04) post-SCS implant between obese and nonobese patients was not attributable to differences in baseline pain scores. There was no significant change in opioid utilization between baseline and 12 months post-SCS therapy.CONCLUSION
A negative association between SCS effectiveness and increasing BMI was found, whereas, no significant difference was noted amongst the various BMI cohorts and the daily opioid consumption. 相似文献2.
Anna Elander Christina Biörserud Trude Staalesen Jonas Ockell Monika Fagevik Olsén 《Surgery for obesity and related diseases》2019,15(2):305-311
Background
Excess skin is well known after massive weight loss but, there is missing knowledge from various groups.Objectives
To describe and compare excess skin in a reference population during obesity, after obesity surgery, and after reconstructive abdominoplasty.Setting
University hospital, Sweden.Methods
The following 6 groups were included: the reference population, obese adults before obesity surgery, obese adults after obesity surgery, adolescents after obesity surgery, super-obese adults after obesity surgery, and adults after abdominoplasty. All groups filled in the Sahlgrenska Excess Skin Questionnaire (SESQ). Some groups also underwent measurements of ptosis/excess skin on 4 body parts.Results
All groups scored significantly higher experience of and discomfort from excess skin compared with the reference population. SESQ scores were significantly higher for obese adults (10.5 ± 8.5) and even higher for adults and adolescents (12.3 ± 8.1 versus 14.4 ± 7.7) after obesity surgery compared with the reference population (1.5 ± 3.5). Abdominoplasty resulted in significantly reduced scores (2.9 ± 5.2). Those undergoing obesity surgery and weight loss had significantly less excess skin measured on arms, breasts, and abdomen compared with before surgery, except for the upper arms on the adolescents. Excess skin increased on inner thighs in both age groups after weight loss. Correlations between objectively measured ptosis/excess skin and the patients’ experience of and discomfort were .16 to .71, and the highest correlations were found among adolescents.Conclusion
Excess skin is not a problem for the vast majority of the normal population but is linked to obesity and massive weight loss. The SESQ score illustrates major problems related to excess skin both for obese adults and after obesity surgery for adults and for adolescents, who have problems similar to or worse than adults. Abdominoplasty markedly decreases symptoms. 相似文献3.
Kevin T. Lynch J. Hunter Mehaffey Robert B. Hawkins Taryn E. Hassinger Peter T. Hallowell Jennifer L. Kirby 《Surgery for obesity and related diseases》2019,15(2):279-285
Background
Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF.Objectives
To assess the association between bariatric surgery and AF prevention.Setting
University Hospital, United States.Methods
All patients who underwent bariatric surgery at a single institution from 1985–2015 (n?=?3,572) were propensity score matched 1:1 to a control population of obese patients with outpatient appointments (n?=?45,750) in our clinical data repository. Patients with a prior diagnosis of AF were excluded. Demographics, relevant comorbidities, and insurance status were collected and a chart review was performed for all patients with AF. Paired univariate analyses were used to compare the two groups.Results
After propensity score matching, 5,044 total patients were included (2,522 surgical, 2,522 non-surgical). There were no differences in preoperative body mass index (BMI) (47.1 vs 47.7 kg/m2, P?=?0.76) or medical comorbidities between groups. The incidence of AF was lower among surgical patients (0.8% vs 2.9%, P?=?0.0001). In patients ultimately diagnosed with AF, time from enrollment to development of AF did not differ between groups; however, surgical patients with AF experienced a significantly higher reduction in excess BMI compared to non-surgical patients with AF (57.9% vs ?3.8%, P<0.001).Conclusion
The incidence of AF was lower among patients who underwent bariatric surgery compared to their medically managed counterparts. Weight reduction with bariatric surgery may reduce the long-term incidence of AF. 相似文献4.
5.
Christina W. Cheng Amy M. Cizik Armagan H.C. Dagal Larissa Lewis John Lynch Carlo Bellabarba Richard J. Bransford Haitao Zhou 《The spine journal》2019,19(4):602-609
BACKGROUND
Surgical site infection (SSI) following spine surgery is associated with increased morbidity, reoperation rates, hospital readmissions, and cost. The incidence of SSI following posterior cervical spine surgery is higher than anterior cervical spine surgery, with rates from 4.5% to 18%. It is well documented that higher body mass index (BMI) is associated with increased risk of SSI after spine surgery. There are only a few studies that examine the correlation of BMI and SSI after posterior cervical instrumented fusion (PCIF) using national databases, however, none that compare trauma and nontraumatic patients.PURPOSE
The purpose of this study is to determine the odds of developing SSI with increasing BMI after PCIF, and to determine the risk of SSI in both trauma and nontraumatic adult patients.STUDY DESIGN
This is a retrospective cohort study of a prospective surgical database collected at one academic institution.PATIENT SAMPLE
The patient sample is from a prospectively collected surgical registry from one institution, which includes patients who underwent PCIF from April 2011 to October 2017.OUTCOME MEASURES
A SSI that required return to the operating room for surgical debridement.METHODS
This is a retrospective cohort study using a prospectively collected database of all spine surgeries performed at our institution from April 2011 to October 2017. We identified 1,406 patients, who underwent PCIF for both traumatic injuries and nontraumatic pathologies using International Classification of Diseases 9 and 10 procedural codes. Thirty-day readmission data were obtained. Patient's demographics, BMI, presence of diabetes, preoperative diagnosis, and surgical procedures performed were identified. Using logistic regression analysis, the risk of SSI associated with every one-unit increase in BMI was determined. This study received no funding. All the authors in this study report no conflict of interests relevant to this study.RESULTS
Of the 1,406 patients identified, 1,143 met our inclusion criteria. Of those patients, 688 had PCIF for traumatic injuries and 454 for nontraumatic pathologies. The incidence of SSI for all patients, who underwent PCIF was 3.9%. There was no significant difference in the rate of SSI between our trauma group and nontraumatic group. There was a higher rate of infection in patients, who were diabetic and with BMI≥30 kg/m2. The presence of both diabetes and BMI≥30 kg/m2 had an added effect on the risk of developing SSI in all patients, who underwent PCIF. Additionally, logistic regression analysis showed that there was a positive difference measure between BMI and SSI. Our results demonstrate that for one-unit increase in BMI, the odds of having a SSI is 1.048 (95% CI: 1.007–1.092, p=.023).CONCLUSIONS
Our study demonstrates that our rate of SSI after PCIF is within the range of what is cited in the literature. Interestingly, we did not see a statistically significant difference in the rate of infection between our trauma and nontrauma group. Overall, diabetes and elevated BMI are associated with increased risk of SSI in all patients, who underwent PCIF with even a higher risk in patient, who are both diabetic and obese. Obese patients should be counseled on elevated SSI risk after PCIF, and those with diabetes should be medically optimized before and after surgery when possible to minimize SSI. 相似文献6.
Michael F. Knox Lucy S. Chipchase Siobhan M. Schabrun Rick J. Romero Paul W.M. Marshall 《The spine journal》2018,18(10):1934-1949
Background context
Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting.Purpose
This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP.Study design
A systematic review of studies was carried out.Patient sample
No patient sample was required.Outcome measures
Between group standardized mean differences and 95% confidence intervals for APAs ad CPAsMethods
A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted.Results
Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses.Conclusions
There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown. 相似文献7.
Konstantinos Arapis Nicoletta Macrina Diana Kadouch Lara Ribeiro Parenti Jean Pierrre Marmuse Boris Hansel 《Surgery for obesity and related diseases》2019,15(1):23-33
Background
Among the population of morbidly obese people, super-super-obese (SSO) individuals (body mass index >60 kg/m2) present a treatment challenge for bariatric surgeons.Objectives
To compare the long-term outcomes between laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) and to evaluate the efficacy of SG as a stand-alone bariatric procedure for SSO patients.Setting
University hospital, Paris, France.Methods
We retrospectively reviewed the data outcomes of 210 SSO patients who underwent SG or RYGB between January 2000 and December 2011. The 6-year follow-up data were analyzed and compared.Results
Follow-up data at 6 years were collected for 57.1% and 52.1% of patients in the SG group and RYGB groups, respectively. Both procedures were effective at promoting weight loss. Most weight loss was achieved at 24 months with both procedures. The average percent excess weight loss and change in body mass index of SG versus RYGB showed no significant differences at the 4-year follow-up. Except for sleep apnea, RYGB showed slightly better resolution of the evaluated co-morbidities. The composite endpoint of major short-term adverse events (<30 d) occurred in 11.7% of patients with RYGB and 6.4% of those with SG (P?=?.02). Postoperative complications were seen in 26% of RYGB patients and 16.1% of SG patients.Conclusions
SG as a primary procedure for SSO patients remains effective even though RYGB achieves better midterm outcomes. SG can be proposed as the primary-option p+rocedure. Further investigations are needed to identify the ideal procedure for patients with symptoms of gastroesophageal reflux disease. 相似文献8.
Arnold W. van de Laar Simon W. Nienhuijs Jan A. Apers Anne-Sophie van Rijswijk Jean-Paul de Zoete Ralph P. Gadiot 《Surgery for obesity and related diseases》2019,15(2):200-210
Background
Current methods for weight loss assessment after bariatric surgery do not meet the high standards required to accurately judge patient outcome in a fair and evidence-based way.Objectives
To build an evidence-based, versatile tool to assess weight loss and weight regain and identify poor responders up to 7 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), for any preoperative body mass index (BMI).Setting
Multicenter, observational study.Methods
Bariatric weight loss charts were built with standard deviation (SD) percentile (p) curves p+2SD/p+1SD/p50(median)/p?1SD/p?2SD, based on all last measured weight results after primary LRYGB and LSG, performed in 3 large bariatric centers, expressed with percentage total weight loss (%TWL) and percentage-alterable weight loss (%AWL), a special BMI-independent metric. The p?1SD %AWL curves were compared with popular bariatric criteria 50% excess weight loss and 20%TWL. The p50 %TWL curves were compared with %TWL outcome in literature (external validation).Results
In total, 9393 patients (5516 LRYGB, 3877 LSG, baseline BMI 43.7 (±SD 5.3) kg/m2, age 43 (±SD 10.9) years, 20% male, 21% type 2 diabetes) had mean follow-up 26 (range, 0–109) months, with .09% 30-day mortality. Independent outcome is presented in percentile charts for %AWL and %TWL. Percentile curves p+2SD/p+1SD/p50/p?1SD/p?2SD showed for LRYGB 72%/62%/50%/38%/28%AWL at nadir, 66%/55%/43%/30%/17%AWL at 4 years, 64%/52%/38%/25%/11%AWL at 7 years, and for LSG 69%/58%/46%/34%/22%AWL, 65%/53%/38%/23%/12%AWL, and 63%/51%/35%/22%/9%AWL, respectively. Bariatric criteria 50% excess weight loss and 20%TWL matched with most insufficient results for LSG, but not for LRYGB (low specificities). Both p50 %TWL curves are comparable with long-term weight loss in bariatric literature.Conclusions
Just as well-known growth charts are essential for pediatrics, weight loss charts should become the tools of choice for bariatrics. These multicenter charts are baseline BMI independent, superior to current bariatric criteria, and quite intuitive to use. They allow to readily detect poor responders in any postoperative phase, monitor the effect of extra counseling, judge weight regain, and manage patient expectations. 相似文献9.
Daniel Gärtner Christine Stroh Martin Hukauf Frank Benedix Thomas Manger 《Surgery for obesity and related diseases》2019,15(2):187-193
Background
Recently, sleeve gastrectomy (SG) has become one of the most important procedures in bariatric surgery. Short-term results show that SG is a feasible, safe, and effective operation treating obesity and its related co-morbidities. Now, the main focus is on long-term data after SG.Objectives
The aim of this study was to analyze perioperative and long-term results after SG in the German Bariatric Surgery Registry.Setting
National database, Germany.Methods
Perioperative data of primary SG (n?=?21525) and follow-up data for 5 years ± 6 months (n?=?435, 18.3% of 2375 SG performed between 2005 and 2011) were analyzed. After a review of the literature long-term results were compared with international data.Results
Mean baseline body mass index (BMI) was 51.1 kg/m2. Two hundred ninety-eight (68.5%) patients were female and 137 (31.5%) were male. Of patients, 90% had ≥1 co-morbidities. Mean operation time was 86 minutes. General postoperative complications occurred in 4.1% and special complications in 4.6% (staple-line leaks 1.6%). Mean maximum BMI loss was 18.0 ± 6.8 kg/m2 and BMI loss after 5 years was 14.3 ± 7.4 kg/m2 (P < .001). Co-morbidities, such as type 2 diabetes, hypertension, and sleep apnea, were significantly improved (P < .001). Gastroesophageal reflux was significantly impaired (P < .001).Conclusions
The current results showed that SG is a safe and effective procedure in bariatric surgery. BMI loss was significant 5 years after SG. Most co-morbidities were significantly improved, but gastroesophageal reflux has often worsened. The follow-up rate was very low, which is a persistent problem in German bariatric surgery. 相似文献10.
Rena C. Moon Vincent Kirkpatrick Lori Gaskins Andre F. Teixeira Muhammad A. Jawad 《Surgery for obesity and related diseases》2019,15(2):245-252
Background
Biliopancreatic diversion with duodenal switch (DS) is known to be superior in weight loss to other bariatric procedures, but with the disadvantage of increased complication rates. Single-anastomosis duodenal-ileal bypass (SADI-S) is reported to have similar weight loss with lower complication rates compared with traditional DS.Objectives
The aim of this study was to compare weight loss and complication rate between SADI-S and double-anastomosis DS at a single institution.Setting
Academic hospital, United States.Methods
A retrospective chart review was performed on 185 patients who underwent laparoscopic or robot-assisted laparoscopic DS between March 1, 2015 and December 10, 2017. A total of 111 patients had SADI-S, and 74 patients underwent double-anastomosis DS.Results
Baseline patient characteristics were comparable between the 2 groups. The mean preoperative body mass index was 56.3 kg/m2 and 54.4 kg/m2 in SADI-S and double-anastomosis DS patients, respectively. Thirteen (11.7%) and 4 (5.4%) patients were readmitted within 30 days after SADI-S and double-anastomosis DS, respectively (P?=?.16). Percentage of total weight loss was 22.0%, 38.5%, and 44.2% in the SADI-S group and 20.2%, 38.0%, and 48.4% in the double-anastomosis DS group at 6, 12, and 24 months, respectively. The majority of patients had vitamin A and E levels in the normal range. However, 40% to 60% of the patients had low levels of vitamin D after the procedure.Conclusions
SADI-S and double-anastomosis DS are comparable in terms of weight loss and complication rate. However, close nutritional follow-up is warranted for both procedures. 相似文献11.
David Gutierrez-Blanco David Romero Funes Marco Castillo Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(2):168-172
Background
Obesity is a major independent risk factor for developing type 2 diabetes (T2D).Objectives
Our goal in this study was to analyze the impact of laparoscopic sleeve gastrectomy in the risk reduction of developing T2D in middle-aged, severely obese nondiabetes patients.Setting
University Hospital, United States.Methods
We retrospectively reviewed our prospectively collected database from 2010 to 2016. All severely obese patients between 45 and 64 years of age without diabetes at baseline that underwent sleeve gastrectomy were included in our study. The T2D risk score for predicting the incidence of diabetes was measured preoperatively and at 12 months postoperatively and was based on the Framingham Offspring Study that calculates an 8-year risk of developing T2D.Results
Of the 1330 patients included in this study, 6.5% (n?=?86) met the criteria for the T2D risk score calculation. The population was predominantly composed of females (68.9%; n?=?59) with a mean age of 52.8 ± 5.3 years. Preoperative body mass index was 43.1 ± 6.9 kg/m2 with a percentage of estimated body mass index loss and percentages of total weight loss were 72.2 ± 26.3% and 26.39 ± 18.15%, respectively, with fasting plasma glucose of 103.3 ± 14.9 mg/dL. The preoperative risk for T2D was 13.9 ± 11.6%, with an absolute risk reduction 12 months after surgery of 10.3%, corresponding to a 74.2% relative risk reduction. When comparing between sexes, risk reduction in females was slightly better than in males; however, this was not statistically significant. At 12-month follow-up, all measured variables were significantly improved, except for diastolic blood pressure.Conclusions
Laparoscopic sleeve gastrectomy significantly decreases the risk of developing T2D in middle-aged severely obese patients. Prospective studies are needed to further understand these findings. 相似文献12.
Abel Boerboom Jens Homan Edo Aarts Theo Aufenacker Ignace Janssen Frits Berends 《Surgery for obesity and related diseases》2019,15(1):60-69
Background
For a number of years the laparoscopic adjustable gastric band has been one of the leading bariatric procedures with good short-term outcomes. However, inadequate weight loss, weight regain, and other band-related complications in the long term led to an increase in revisional Roux-en-Y gastric bypass (RYGB) procedures. Lengthening the biliopancreatic limb, a relatively simple and safe adjustment of the standard technique, could improve the results of the revisional procedure.Objectives
The aim of this randomized controlled trial was to evaluate the effect of a long biliopancreatic limb RYGB (LBP-GB) and standard RYGB (S-GB) as revisional procedure after laparoscopic adjustable gastric band.Setting
General hospital specialized in bariatric surgeryMethods
One hundred forty-six patients were randomized in 2 groups; 73 patients underwent an S-GB (alimentary/biliopancreatic limb 150/75 cm), and 73 patients underwent LBP-GB (alimentary/biliopancreatic limb 75/150). Weight loss, remission of co-morbidities, quality of life, and complications were assessed during a period of 4 years.Results
Baseline characteristics between the groups were comparable. At 48 months the follow-up rate was 95%. Mean total weight loss after 24 months was 27% for LBP-GB versus 22% S-GB (P?=?.015); mean total weight loss after 48 months was 23% and 18%, respectively (P?=?.036). No significant differences in other parameters were found between the groups.Conclusions
A LBP-GB as revisional procedure after a failing laparoscopic adjustable gastric band improves short- and long-term total weight loss compared with an S-GB. Together with future modifications this technically simple adjustment of the RYGB could significantly improve disappointing results after revisional surgery. 相似文献13.
Bong Gun Lee Jung-Hwan Choi Dong-Yun Kim Won Rak Choi Seung Gun Lee Chang-Nam Kang 《The spine journal》2019,19(2):301-305
Background context
It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.Purpose
The purpose of this study was to investigate the risk factors for newly developed OVCFs after treatment by vertebroplasty (VP), kyphoplasty (KP), or conservative treatment.Study design/setting
A retrospective comparative study.Patient sample
One hundred thirty-two patients who had radiographic follow-up data for one year or longer among 356 patients who were diagnosed with OVCF and underwent VP, KP or conservative treatment between March 2007 and February 2016.Outcome measures
All records were examined for age, sex, body mass index (BMI), rheumatoid arthritis and other medical comorbidities, osteoporosis medication, bone mineral density (BMD), history of vertebral and nonvertebral fractures, treatment methods used, level of fractures, and presence of multiple fracture sites.Methods
Patients were divided into those who manifested new OVCF (Group A) and those who did not (Group B). For the risk factor analysis, student's t-tests and chi-square tests were used in univariate analysis. Multivariate logistic regression analysis was carried out on variables with a p<.1 in the univariate analysis.Results
Newly developed OVCFs occurred in 46 of the 132 patients (34.8%). Newly developed OVCF increased significantly with factors such as average age (p=.047), low BMD T-score of the lumbar spine (p=.04) and of the femoral neck (p=.046), advanced age (>70 years) (p=.011), treatment by cement augmentation (p=.047) and low compliance with osteoporosis medication (p=.029). In multivariate regression analysis, BMD T-score of the lumbar spine (p=.009) and treatment by cement augmentation (p=.044) showed significant correlations with the occurrence of new OVCFs with a predictability of 71.4%.Conclusion
Osteoporotic vertebral compression fracture patients with low BMD T-score of the lumbar spine and those who have been treated by cement augmentation have an increased risk of new OVCFs after treatment and, therefore, require especially careful observation and attention. 相似文献14.
Shinichi Ishihara Nobuyuki Fujita Koichiro Azuma Takehiro Michikawa Mitsuru Yagi Takashi Tsuji Michiyo Takayama Hideo Matsumoto Masaya Nakamura Morio Matsumoto Kota Watanabe 《The spine journal》2019,19(3):493-500
BACKGROUND CONTEXT
Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted.PURPOSE
To elucidate potential association between SEL and metabolic syndrome.STUDY DESIGN
An observational study used data of a medical checkup.PATIENT SAMPLE
We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study.OUTCOME MEASURES
The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated.METHODS
The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated.RESULTS
The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5–9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm2 (OR=4.8, 95% CI=1.5–15.3) and hypertension (OR=3.5, 95% CI=1.1–11.8) were observed to be independently associated with SEL.CONCLUSION
This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome. 相似文献15.
Jose Melendez-Rosado David Gutierrez-Blanco Alison Schneider Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(2):288-294
Background
Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in the United States; however, it can be associated with development of de novo gastroesophageal reflux (GERD) or worsening of existing GERD. Preoperative esophagogastroduodenoscopy (EGD) and findings of esophagitis are commonly used as screening tool, but the alternative use of preoperative objective measurement of acid reflux has not been studied.Objective
The aim of this study was to evaluate if preoperative objective measurement of acid reflux by using wireless pH monitoring (WPHM) could have an impact on surgical planning and outcomes.Setting
Academic Center of Excellence.Methods
Retrospective review of a prospectively collected database of 43 adult obese patients with reflux symptoms who underwent outpatient EGD and WPHM between September 2011 and September 2017.Results
Change in planned surgical management from SG to Roux-en-Y-gastric bypass with the use of WPHM occurred in 21.0% (n?=?9) of patients. Only 2.3% (n?=?1) developed de novo GERD after SG. Nonerosive reflux disease was the most common esophageal condition on preoperative EGD. EGD, as a single diagnostic tool, appeared insufficient to diagnose acid reflux and help with the decision planning in this patient population.Conclusions
Based on objective data obtained by measurement of GERD, using preoperative WPHM compared with preoperative EGD alone aids in a better patient selection for either SG or Roux-en-Y-gastric bypass. Our cohort with preoperative WPHM required no surgical conversions or revisions. 相似文献16.
Marie-Maëlle Chandeze David Moszkowicz Alain Beauchet Karina Vychnevskaia Frédérique Peschaud Jean-Luc Bouillot 《Surgery for obesity and related diseases》2019,15(1):83-88
Background
Obesity is a risk factor for the development of ventral hernia and increases the risk of recurrence and surgical site infection after hernia repair (HR).Objectives
We tested the hypothesis that bariatric surgery (BS) before HR would decrease these risks in patients with morbid obesity.Setting
University hospital, France.Methods
We retrospectively compared 2 groups of patients with morbid obesity in a case-matched study; 1 underwent immediate HR surgery (control), and the other initially underwent BS and then HR after weight loss (case). Patients were individually matched at a 2:1 ratio according to defect size (<7 or ≥7 cm), obesity grade (<40 or ≥40 kg/m²), American Society of Anesthesiologists score, sex, smoker status, and presence of chronic obstructive pulmonary disease.Results
From 2000 to 2017, 41 patients underwent BS, in association with herniorrhaphy in 14 cases (34%). Initial body mass index was higher in the BS group (46.7 ± 6.4 versus 42.4 ± 7.2, P < .0001) but had decreased by the time of HR (34.1 ± 6.5 versus 42.3 ± 7.2, P < .0001). Prosthetic HR was performed after 21.5 months (range, 7–87); however, 7 patients did not receive HR at this time due to insufficient weight loss. Postoperative morbidity was similar in the 2 groups. Hospital stay was shorter in the BS group (6.2 ± 2.6 versus 10.7 ± 9.3 d, P?=?.002). After a median follow-up of 4.6 ± 4.1 years, the recurrence rate was lower in the BS group (2/30, 6.7%) than in the control group (12/50, 24%; P?=?.048).Conclusion
For morbidly obese patients with ventral hernia, BS before HR surgery can decrease recurrence without increasing morbidity. 相似文献17.
BACKGROUND CONTEXT
Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis.PURPOSE
This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis.STUDY DESIGN/SETTING
A retrospective comparative study.PATIENT SAMPLE
PVO patients with osteoporosis.OUTCOME MEASURES
Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death.METHODS
PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest.RESULTS
A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p?=?.014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p?=?.001 for model 1 and p?=?.002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups.CONCLUSIONS
Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery. 相似文献18.
Lindsay Wakayama Katherine Nameth Sarah Adler Debra L. Safer 《Surgery for obesity and related diseases》2019,15(1):91-96
Background
Sarwer et al. found that poor dietary adherence at 6 months postoperatively predicted lower weight loss.Objectives
To replicate and extend these findings.Setting
University bariatric clinic.Methods
Fifty-four adults (72% female; age 51.1 ± 11.3 yr; mean body mass index [BMI]?=?43.8 ± 7.4 kg/m2; 53.7%?=?Roux-en-Y gastric bypass, 42.6%?=?laparoscopic sleeve gastrectomy, and 3.7%?=?gastric banding) were identified as low or high dietary adherers following the method of Sarwer et al. Patients self-reported dietary adherence with a 9-point Likert scale. Splitting the group at the median, low adherers scored <7 and high dietary adherers ≥7. BMI, percentage excess weight loss (%EWL), and percentage total weight loss (%TWL) were prospectively assessed at 12, 24, and 36 months. Two-tailed independent t tests and Cohen's d effect sizes were used to compare between-group outcomes.Results
BMI did not differ between low (n?=?24) and high (n?=?30) dietary adherers at 6 months after surgery. At 12 months, the BMI of low (n?=?17) adheres was significantly higher (34.1 ± 4.61 versus 30.3 ± 3.90 kg/m2, P?=?.006, d?=?0.90) than that of high (n?=?25) adherers, with significantly less %EWL (49.0 ± 24% versus 70.7 ± 21.5%; P?=?.004; d?=?0.95) and %TWL (20.7 ± 11.5% versus 28.9 ± 10.5, P?=?.02, d = 0.74). At 24 months, BMI remained significantly higher for low (n?=?12) versus high (n?=?10) adherers (33.7 ± 4.77 versus 29.7 ± 3.82 kg/m2, P?=?.045, d?=?0.92), but %EWL and %TWL were not significantly different, despite large effect sizes. At 36 months, moderate effects supported continued higher BMIs and lower %EWL and %TWL for low (n?=?5) versus high (n?=?8) adherers. Attrition from follow-up was 22.2% (12 mo), 59.3% (24 mo), and 75.9% (36 mo). Post hoc analyses revealed no impact of baseline characteristics on low follow-up rates except younger age (at 1 yr).Conclusions
Findings that 6-month postoperative dietary adherence predicts 12-month BMI, %EWL, and %TWL were replicated. Medium to large effects suggest findings extend to 24 and 36 months, with low follow-up rates likely affecting statistical significance. 相似文献19.
Marko Tomov Nathan Wanderman Elie Berbari Bradford Currier Michael Yaszemski Ahmad Nassr Paul Huddleston Mohamad Bydon Brett Freedman 《The spine journal》2019,19(2):267-275
BACKGROUND CONTEXT
Surgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system.PURPOSE
Review the impact and cost effectiveness of 5 SSI prevention interventions on SSI rates in an orthopedic spine surgery practice at a major quaternary healthcare system over a 10-year period.STUDY DESIGN
Retrospective observational study.PATIENT SAMPLE
All of the surgical patients of the 5 spine surgeons in our department over a 10-year period were included in this study.OUTCOME MEASURES
SSI rates per year, standardized infection ratios (SIR) for laminectomies and fusions during the most recent 3-year period, year of implementation, and frequency of use of the different interventions, cost of the techniques.METHODS
The SSI prevention techniques described in this paper include application of intrawound vancomycin powder, wound irrigation with dilute betadine solution, preoperative chlorhexidine gluconate scrubs, preoperative screening with nasal swabbing, and decolonization of S. aureus, and perioperative antibiotic administration. Our institution's infection prevention and control data were analyzed for the yearly SSI rates for the orthopedic spine surgery department from 2006 to 2016. In addition, our orthopedic spine surgeons were polled to determine with what frequency and duration they have been using the different SSI prevention interventions.RESULTS
SSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final 6 years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the period from 2013 to 2016. All surgeons polled at our institution uniformly used perioperative antibiotics, Hibiclens scrub, and the nasal swab protocol since the implementation of these techniques. Some variability existed in the frequency and duration of betadine irrigation and application of vancomycin powder. A cost analysis demonstrated these methods to be nominal compared with the cost of treating a single SSI.CONCLUSIONS
It is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner. 相似文献20.
José Miguel Spirig Reto Sutter Tobias Götschi Nadja A. Farshad-Amacker Mazda Farshad 《The spine journal》2019,19(3):461-468