Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy

Jackson, Rubie Sue; Black, James H.; Lum, Ying Wei; Schneider, Eric B.; Freischlag, Julie A.; Perler, Bruce A.; Abularrage, Christopher J.

doi:10.1016/j.jvs.2011.11.135

Cited by 44 publications

(42 citation statements)

References 24 publications

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“…Thus, one can speculate that the detrimental effects of long-term overnutrition on surgery are likely to stem from perturbations in these metabolic parameters rather than directly from the absolute amount of adipose tissue. This position is supported by the observation that obesity itself often does not correlate with surgical outcome 29 ; indeed, increased adiposity itself is not mutually exclusive of a healthy metabolic profile 30 .…”

Section: Discussionmentioning

confidence: 97%

Preoperative dietary restriction reduces intimal hyperplasia and protects from ischemia-reperfusion injury

Mauro

Tao

et al. 2016

Journal of Vascular Surgery

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Objective While chronic overnutrition is a risk factor for surgical complications, long-term dietary restriction (reduced food intake without malnutrition) protects in pre-clinical models of surgical stress. Building on the emerging concept that acute preoperative dietary perturbations can affect the body’s response to surgical stress, we hypothesized that short-term high-fat diet feeding prior to surgery is detrimental, while short-term nutrient/energy restriction prior to surgery can reverse negative outcomes. We tested this hypothesis in two distinct murine models of vascular surgical injury, ischemia reperfusion and intimal hyperplasia. Methods Short-term overnutrition was achieved by feeding mice a high fat diet consisting of 60% calories from fat for two weeks. Short-term dietary restriction consisted of either 1 week of restricted access to a protein free diet (protein/energy restriction) or 3 days of water-only fasting immediately prior to surgery; after surgery, all mice were given ad libitum access to a complete diet. To assess the impact of pre-operative nutrition on surgical outcome, mice were challenged in one of two fundamentally distinct surgical injury models: ischemia reperfusion injury (IR) to either kidney or liver; or a carotid focal stenosis model of intimal hyperplasia (IH). Results Three days of fasting or 1 week of preoperative protein/energy restriction attenuated IH development measured 28 days after focal carotid stenosis. One week of preoperative protein/energy restriction also reduced plasma urea, creatinine and damage to the cortico-medullary junction after renal IR, and decreased AST, ALT and hemorrhagic necrosis after hepatic IR. However, exposure to a high fat diet for 2 weeks prior to surgery had no significant impact on kidney or hepatic function following IR, nor intimal hyperplasia following focal carotid stenosis. Conclusions Short-term dietary restriction immediately before surgery significantly attenuated the vascular wall hyperplastic response and improved IR outcome. The findings suggest plasticity in the body’s response to these vascular surgical injuries that can be manipulated by novel yet practical preoperative dietary interventions.

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Section: Discussionmentioning

confidence: 97%

Preoperative dietary restriction reduces intimal hyperplasia and protects from ischemia-reperfusion injury

Mauro

Tao

et al. 2016

Journal of Vascular Surgery

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“…26,27 This unexpected relationship may be attributable to the actions of endocrine factors released from adipose tissue. 27 This was not an epidemiological study because the sample patients were referred to a tertiary hospital. This causes sample bias, although they were severely affected patients who required no primary treatment.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis

et al. 2015

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“…1,4,5,25 A growing body of literature has been reporting an obesity paradox such that in patients with a variety of illnesses, including postoperative patients, obesity is associated with reduced mortality. 16,[26][27][28][29] Although the phenomenon of the obesity paradox is not entirely understood, possible explanations in favor of causality have included earlier presentation to medical care as well as more optimal medical therapy, [30][31][32] cardioprotective metabolic effects of increased body fat, 33 and increased metabolic reserves. 34 Another invoked putative mechanism by which SDB could decrease mortality is ischemia preconditioning.…”

Section: Discussionmentioning

confidence: 99%

Sleep-Disordered Breathing and Postoperative Outcomes After Elective Surgery

Mokhlesi¹,

Hovda²,

Vekhter³

et al. 2013

Chest

181

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Sleep-disordered breathing (SDB) is increasingly recognized as a possible risk factor for adverse perioperative outcomes. [1][2][3][4][5][6] Given the important implications of untreated SDB, the American Society of Anesthesiologists recommends screening patients prior to surgery for SDB and implementing treatment if SDB is present. 7 However, despite this growing awareness, there is a paucity of large-scale studies that examined the impact of SDB on postoperative outcomes. Moreover, given that systematic screening would impose a Background: Systematic screening and treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in presurgical patients would impose a signifi cant cost burden; therefore, it is important to understand whether SDB is associated with worse postoperative outcomes. We sought to determine the impact of SDB on postoperative outcomes in patients undergoing four specifi c categories of elective surgery (orthopedic, prostate, abdominal, and cardiovascular). The primary outcomes were in-hospital death, total charges, and length of stay (LOS). Two secondary outcomes of interest were respiratory and cardiac complications. Methods: Data were obtained from the Nationwide Inpatient Sample database. Regression models were fi tted to assess the independent association between SDB and the outcomes of interest. 73; P , .001) but had no impact on mortality in the prostate surgery group. SDB was independently associated with a small, but statistically signifi cant increase in estimated mean LOS by 0.14 days ( P , .001) and estimated mean total charges by $860 ( P , .001) in the orthopedic surgery group but was not associated with increased LOS or total charges in the prostate surgery group. In the abdominal and cardiovascular surgery groups, SDB was associated with a signifi cant decrease in adjusted mean LOS of 1.1 days and 0.35 days, respectively ( P , .001 for both groups), and adjusted mean total charges of $3,814 and $4,592, respectively ( P , .001 for both groups). SDB was independently associated with a signifi cantly increased OR for emergent intubation and mechanical ventilation, noninvasive ventilation, and atrial fi brillation in all four surgical categories. Emergent intubation occurred signifi cantly earlier in the postoperative course in patients with SDB. In the subgroup of patients requiring emergent intubation, LOS, total charges, pneumonias, and in-hospital death were signifi cantly higher in those without SDB. Conclusions: In this large national study, despite the increased independent association of SDB with postoperative cardiopulmonary complications, the diagnosis of SDB was not independently associated with an increased rate of in-hospital death. SDB had a mixed impact on LOS and total charges by surgical category.

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Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy

Cited by 44 publications

References 24 publications

Preoperative dietary restriction reduces intimal hyperplasia and protects from ischemia-reperfusion injury

Preoperative dietary restriction reduces intimal hyperplasia and protects from ischemia-reperfusion injury

Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis

Sleep-Disordered Breathing and Postoperative Outcomes After Elective Surgery

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