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1.
Gugliotti D Grant P Jaber W Aboussouan L Bae C Sessler D Scahuer P Kaw R 《Obesity surgery》2008,18(1):129-133
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is thus considered an intermediate-
to high-risk noncardiac surgery. Most patients referred for bariatric surgery have a low or very low functional capacity,
making cardiac risk assessment imperative. Stress echocardiography has a high negative predictive value and can avoid some
of the table weight and torso diameter problems associated with myocardial perfusion imaging. Echocardiograph contrast agents
improve the ability to identify endocardial borders and assess ventricular wall motion and may be used with stress and nonstress
imaging protocols. Single photon emission computer tomography (SPECT) imaging with attenuation correction, combined supine
and prone imaging, use of technetium isotope, and positron emission tomography (PET) imaging may all provide some advantage
for myocardial perfusion imaging for the obese patient. 相似文献
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Dietric L. Hennings Maria Baimas-George Zaid Al-Quarayshi Rachel Moore Emad Kandil Christopher G. DuCoin 《Obesity surgery》2018,28(1):44-51
Objective
Bariatric surgery has been shown to be the most effective method of achieving weight loss and alleviating obesity-related comorbidities. Yet, it is not being used equitably. This study seeks to identify if there is a disparity in payer status of patients undergoing bariatric surgery and what factors are associated with this disparity.Methods
We performed a case-control analysis of National Inpatient Sample. We identified adults with body mass index (BMI) greater than or equal to 25 kg/m2 who underwent bariatric surgery and matched them with overweight inpatient adult controls not undergoing surgery. The sample was analyzed using multivariate logistic regression.Results
We identified 132,342 cases, in which the majority had private insurance (72.8%). Bariatric patients were significantly more likely to be privately insured than any other payer status; Medicare- and Medicaid-covered patients accounted for a low percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29–0.37, p < 0.001; Medicaid 8.7%, OR 0.21, 95% CI 0.18–0.25, p < 0.001). Medicare (OR 1.54, 95% CI 1.33–1.78, p < 0.001) and Medicaid (OR 1.31, 95% CI 1.08–1.60, p = 0.007) patients undergoing bariatric surgery had an increased risk of complications compared to privately insured patients.Conclusions
Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.4.
Amin Andalib Ali Aminian Zhamak Khorgami Mohammad H. Jamal Toms Augustin Philip R. Schauer Stacy A. Brethauer 《Obesity surgery》2016,26(7):1479-1486
Background
Previous research suggests that patients on chronic steroids may be at an increased risk of postoperative morbidity after major surgery. We aimed to evaluate the prognostic impact of chronic use of steroid or immunosuppression on 30-day morbidity and mortality rates after primary bariatric surgery.Methods
From American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified patients who underwent primary bariatric surgery between 2005 and 2013. Logistic regression was used to determine the prognostic impact of chronic use of steroid or immunosuppression on the 30-day postoperative outcomes.Results
One thousand two hundred seventy seven steroid/immunosuppressant-dependent (SD) and 112,892 non-dependent (ND) patients were analyzed. SD patients had a higher baseline risk profile compared to ND patients. Thirty-day mortality rates for SD and ND patients were 0.55 and 0.11 %, respectively (P?<?0.001) which corresponds to an adjusted odds ration (OR) of 6.85 (95 % confidence interval (CI) 1.95–24.12). SD patients had a higher 30-day major morbidity compared to ND patients (5.01 versus 2.54 %; P?<?0.001, respectively). After adjustment, this translated into an OR of 2.21 (95 % CI 1.29–3.79). Among SD patients, there was no significant difference in 30-day major morbidity after gastric bypass compared to sleeve gastrectomy (OR?=?0.36; 95 % CI 0.08–1.66).Conclusions
Chronic and active use of steroid or immunosuppressant medications is a strong predictor of 30-day postoperative morbidity and mortality following primary bariatric surgery. Among the steroid/immunosuppressant users, complication rates were similar for gastric bypass and sleeve gastrectomy patients. Further studies are needed to help guide the management or discontinuation of such medications in the perioperative period.5.
Ali Aminian Amin Andalib Maria R. Ver Ricard Corcelles Philip R. Schauer Stacy A. Brethauer 《Obesity surgery》2016,26(6):1186-1190
Background
Obesity has become prevalent in patients with inflammatory bowel disease (IBD). Bariatric surgery can be considered to be contraindicated in IBD patients. We aimed to evaluate feasibility, safety, and efficacy of bariatric surgery in IBD patients.Methods
We retrospectively identified all morbidly obese patients with a known diagnosis of IBD, who underwent bariatric surgery between January 2005 and December 2012. Postoperative outcomes and status of IBD in patients on maintenance therapy for their disease were assessed.Results
We identified 20 IBD patients including 13 ulcerative colitis (UC) and 7 Crohn’s disease (CD) patients with a mean age of 54.0?±?10.5 years, BMI of 50.1?±?9.0 kg/m2, and duration of IBD of 11.3?±?5.2 years. Eleven patients were on medication for IBD at baseline. Bariatric procedures included sleeve gastrectomy (N?=?9), gastric bypass (N?=?7), gastric banding (N?=?3), and one conversion of band to gastric bypass. There were no intraoperative complications, but two conversions to laparotomy due to adhesions. Mean BMI change and excess weight loss at 1 year was 14.3?±?5.7 kg/m2 and 58.9?±?21.1 %, respectively. Seven early postoperative complications occurred including dehydration (N?=?5), pulmonary embolism (N?=?1), and wound infection (N?=?1). During a mean follow-up of 34.6?±?21.7 months, five patients developed complications including pancreatitis (N?=?2), ventral hernia (N?=?2), and marginal ulcer (N?=?1). Nine out of ten eligible patients experienced improvement in their IBD status.Conclusions
Bariatric surgery is feasible and safe in morbidly obese patients suffering from IBD. In addition to being an effective weight loss procedure, bariatric surgery may help mitigate symptoms in this patient population.6.
Background
Sarcopenic obesity is the combination of low muscle mass and strength with increased fat mass. This condition is associated with negative health outcomes. We hypothesized that sarcopenia could be a pejorative factor on surgical weight loss.Objective
The objectives of the study are to determine the influence of sarcopenic obesity on gastric bypass and sleeve gastrectomy results regarding weight loss and comorbidities resolution at 3, 6, and 12 months.Setting
The study was conducted at the University Hospital.Methods
Sixty-nine obese patients who benefited from bariatric surgery were included. Skeletal muscle mass was determined by the Janssen’s equation. Physical performance and muscle strength were determined using the 6-min walk test and the wall sit test. Obese subjects from the lowest tertile of the Skeletal Muscle mass Index (SMI) of Baumgartner were set as sarcopenic.Results
Weight loss outcomes and rate of weight loss failure were not influenced by sarcopenia. At 1 year, mean EBMIL% was 75.4 %?±?5 in sarcopenic subjects vs 67.8 % ±4 in the non-sarcopenic subjects (p?=?0.242). Improvement rates of co-morbidities were similar between groups. Skeletal muscle mass was no more different between groups at 1 year after surgery. There was no patient lost to follow-up.Conclusions
Bariatric surgery remains effective in achieving weight loss target in sarcopenic patients, with similar remission rates of main comorbidities and similar safety profile than in the non-sarcopenic group. Whether bariatric surgery could result in improvement or deterioration of daily living activities disabilities and functional autonomy in sarcopenic obese patients still have to be evaluated.7.
Background Psychologists play an important role as members of the bariatric surgery team. The current investigation examined the frequency
with which psychologists recommend delay or denial of surgery for psychological reasons, the procedures they use in making
their clinical decisions, and the reasons for such conclusions.
Method A sample of 103 psychologists with experience in conducting pre-surgical psychological evaluations responded to a brief survey.
Results There was significant variability in the number of evaluations psychologists complete and the instruments they use to make
their clinical decisions. For most candidates, the evaluation results in psychological clearance for surgery. However, approximately
15%, on average, are delayed or denied for psychological reasons. The most common reasons for delaying or denying surgery
were significant psychopathology (including psychosis or bipolar disorder), untreated or undertreated depression, and lack
of understanding about the risks and postoperative requirements of surgery, which were reported by 51, 39, and 30% of respondents,
respectively. Several other reasons were reported less frequently and many appeared to be idiosyncratic.
Conclusion Psychologists differ in their preoperative evaluation practices. Further research is needed to determine the reasons for the
variability in clinical decision making and the long-term medical and psychosocial outcomes associated with the recommendation
to delay or deny surgery for psychosocial reasons. When patients receive such a recommendation, they can be encouraged to
seek a second opinion from a mental health professional with bariatric expertise. 相似文献
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Haddad Ashraf Kow Lilian Herrera Miguel F. Cohen Ricardo V. Himpens Jacques Greve Jan Willem Shikora Scott 《Obesity surgery》2022,32(10):3217-3230
Obesity Surgery - With the rise in obesity and bariatric procedures worldwide, there has been a surge in new and innovative procedures that has been increasingly offered to patients. In this... 相似文献
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Kaw R Aboussouan L Auckley D Bae C Gugliotti D Grant P Jaber W Schauer P Sessler D 《Obesity surgery》2008,18(1):134-138
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk
non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension
and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to
posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be
kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position,
preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve
oxygenation in the perioperative period. 相似文献
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Arthi Kumaravel Andrea Zelisko Philip Schauer Rocio Lopez Matthew Kroh Tyler Stevens 《Obesity surgery》2014,24(12):2025-2030
Background
The incidence of acute pancreatitis (AP) in bariatric surgery patients is not known. Ouraim was to determine the incidence, outcomes, and risk factors of AP in post-bariatric surgery patients.Methods
An historical cohort study was conducted of all patients who underwent Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric banding, and revisional procedures at our institution from January 2004 to September 2011. Patients who developed AP were identified by review of the electronic medical record. A nested case-control study using Cox regression analysis was done to identify risk factors.Results
A total of 2695 patients underwent bariatric surgery. Twenty-eight patients (1.04 %) developed AP during a median follow-up of 3.5 years (interquartile range [IQR] 1.9–5.8). One patient had severe AP, and there was one AP-related death. In the case-control study, the only baseline variable that predicted post-operative AP was a prior history of AP. Three other variables identified after surgery were associated with AP: (1) rapid weight loss as measured by percent of excess weight loss (EWL) at the first post-operative visit, (2) abnormal findings on post-operative ultrasound (stones, sludge or ductal dilation), and (3) post-operative complications of bowel leak or anastomotic stricture.Conclusions
The incidence of AP in this cohort is 1.04 %, which is higher than that reported for the general population (~17/100,000, 0.017 %). Most cases were clinically mild and managed conservatively with good outcomes. Rapid post-operative weight loss and the presence of gallstones or sludge on post-operative ultrasound were significant risk factors for AP. 相似文献12.
Background: Obese patients undergoing bariatric surgery are at significant risk for venous thromboembolism (VTE). We performed
a multicenter, retrospective survey to evaluate the safety and efficacy of enoxaparin for thromboprophylaxis in patients with
morbid obesity undergoing primary bariatric surgery. Methods: From January to December 2002, 668 patients who underwent primary
bariatric surgery at 5 centers were analyzed retrospectively. Baseline patient demographics, objectively diagnosed cases of
VTE, and bleeding events were recorded. Patients received enoxaparin preoperatively (30 mg) or postoperatively (40 mg) every
12 or 24 hours or upon discharge (30 mg every 24 hours for 10 days). Results: Overall, there were 6 (0.9%) pulmonary embolisms
(PE) and 1 (0.1%) occurrence of deep vein thrombosis (DVT); all but 1 occurred after the cessation of thromboprophylaxis.
The highest incidence of VTE was at Center B, which did not administer perioperative thromboprophylaxis (1 DVT and 2 PEs).
There were 6 (0.9%) severe bleeding complications: 3 at center D and 3 at center E. In Center B, 2 deaths were recorded (0.3%):
1 due to sepsis and 1 due to bleeding, with both occurring after thromboprophylaxis was discontinued. Conclusion: The administration
of enoxaparin, in various dosing regimens, is safe for thromboprophylaxis in morbidly obese patients undergoing bariatric
surgery. Fewer events occurred with perioperative prophylaxis initiated in the hospital. Because all thromboembolic events
occurred after the cessation of thromboprophylaxis, extended thromboprophylaxis may be of value. 相似文献
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Steinmann WC Suttmoeller K Chitima-Matsiga R Nagam N Suttmoeller NR Halstenson NA 《Obesity surgery》2011,21(9):1323-1329
Background
Bariatric surgery is the most effective obesity treatment in terms of weight loss and resolution of comorbidities. Roux-en-Y bypass surgery achieves weight loss of 60% to 70% excess body weight in most morbidly obese individuals. Patients with psychological disorders are reported to have less optimal results and those with bipolar, possibly worse. 相似文献16.
The purpose of this study was to describe vitamin and nutrient supplement practices and assess medication dosage formulations utilized in patients hospitalized with a history of bariatric surgery. Retrospective pilot study was conducted from January 1, 2006 through December 31, 2007 in patients with a past history of bariatric surgery. Demographic data, vitamin and nutrient supplements, and medication dosage formulations were evaluated upon admission. This was compared to published guidelines. Compliance with the following supplementation was categorized: daily multivitamin, calcium, iron, vitamin B-12, and folic acid. The frequency of non-immediate-release and enteric-coated medication dosage forms was also examined. Discrepancies were identified as lack of one of the supplements or if an inappropriate dosage formulation was ordered. Of 133 admissions, 117 (88%) had a history of a malabsorptive procedure and at least one discrepancy was found. Only 33.3% of admissions were ordered a multivitamin, 5.1% were ordered supplemental vitamin B-12, and 7.7% received a calcium supplement. Additional folic acid was ordered in 11.1% and iron ordered in 12.0%. Inappropriate medication formulations were ordered in 61.5% of patients; 34.7% included non-immediate-release formulations, 25.0% enteric-coated formulations, and 40.3% both non-immediate-release and enteric-coated. Upon discharge from the institution, 50% had inappropriate formulations continued. Patients with a history of bariatric surgery may not have their vitamin and nutrient needs met upon hospitalization. Prior bariatric surgery is not consistently taken into consideration when ordering medications. Healthcare providers need to be cognizant of vitamin regimens to recommend as well as medication dosage formulations to avoid. 相似文献
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Dorman RB Abraham AA Al-Refaie WB Parsons HM Ikramuddin S Habermann EB 《Journal of gastrointestinal surgery》2012,16(1):35-44
Introduction
Mortality and complications following bariatric surgery occur at acceptable rates, but its safety in the elderly population is unknown. We hypothesized that short-term operative outcomes in bariatric surgery patients ≥65 years would be comparable to younger persons. 相似文献18.
Vanetta Carolina Dreifuss Nicolás H. Schlottmann Francisco Baz Carolina Masrur Mario A. 《Obesity surgery》2022,32(10):3248-3256
Obesity Surgery - The demand for revisional bariatric surgery has increased, and bariatric conversions (BC) to a different procedure represent most of the revisional cases. The 2020 Metabolic and... 相似文献
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Obesity has been associated with poor graft and patient survival after kidney transplantation, requiring functional increase
of anti-rejection drugs. Weight loss surgery may be a good alternative in this clinical scenario. The aim of this report is
to describe the outcomes of bariatric procedures performed in patients after kidney transplantation at our institution. A
retrospective chart review of a prospectively collected database was conducted to analyze the outcomes of morbidly obese patients
after kidney transplantation who underwent laparoscopic bariatric procedures between November 2004 and October 2007. Our series
included five patients who underwent a bariatric procedure following kidney transplantation. All patients were females, with
a mean age of 40.8 years (range 30–48) and mean body mass index (BMI) of 52.2 (range 48–69). Percent of excess weight loss
(%EWL) at 2 years was over 50% for all patients; other comorbidities that might affect postoperative renal function were diabetes
mellitus in 2/5 patients, hypertension in 5/5 patients, and chronic heart failure in 1/5 patients. Four patients had laparoscopic
Roux-en-Y gastric bypass and one had laparoscopic sleeve gastrectomy. There were no postoperative complications in any patients,
and no alteration to the dosages of the immunosuppressant drugs were recorded after bariatric surgery. Laparoscopic bariatric
surgical techniques may be used safely and effectively to control obesity in renal transplant patients. 相似文献