Obesity in general elective surgery

Dindo, Daniel; Müller, Markus K.; Weber, Markus; Clavien, Pierre‐Alain

doi:10.1016/s0140-6736(03)13640-9

Cited by 585 publications

(390 citation statements)

References 25 publications

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“…One possible explanation is the greater amount of adipose tissue encountered at the hip during THA than at the knee during TKA. In this regard, it is known poor vascularity of adipose tissue has been linked with infection after abdominal surgery in obese patients [5,10,24]. We could find no other study reporting on deep prosthetic infection with a comparable number of morbidly obese patients.…”

Section: Discussionmentioning

confidence: 85%

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Dowsey

Choong

2008

Clin Orthop Relat Res

225

138

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We conducted a prospective study of 1214 consecutive primary TKAs to compare the deep prosthetic infection rate between obese and nonobese patients during the first 12 months after surgery. We also sought to determine whether patient or surgical variables such as comorbidities, age, gender, blood transfusion, use of surgical drains, and antibiotic-impregnated cement were predictors of subsequent prosthetic infection after primary TKA. The overall prosthetic infection rate was 1.5% (n = 18). The odds for a deep prosthetic infection were greater in patients with morbid obesity (odds ratio [OR], 8.96; 95% confidence interval, 1.59-50.63) and diabetes (OR, 6.87; 95% confidence interval, 2.42-19.56). Men were more likely to have a prosthetic infection develop than women (OR, 5.93; 95% confidence interval, 1.95-18.04) and the prosthetic infection rate was lower (OR, 0.24; 95% confidence interval, 0.06-0.95) in patients when a surgical drain was used. There were no prosthetic infections in patients with diabetes who were not obese.This compares with 11 prosthetic infections in patients who were obese and diabetic and four prosthetic infections in patients who were obese but not diabetic. Morbid obesity and obesity combined with diabetes are risk factors for periprosthetic infection after TKA.

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Section: Discussionmentioning

confidence: 85%

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Dowsey

Choong

2008

Clin Orthop Relat Res

225

138

View full text Add to dashboard Cite

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“…SSI is the most common complication after colectomy, and obesity or overweight is thought to increase this risk by 2.5-to 5-fold as compared with patients of normal weight [13][14][15][16]. This risk may be related to the decreased oxygen tension in relatively avascular adipose tissue, differences in wound healing, greater wound size, or technical difficulties [13,17].…”

Section: Discussionmentioning

confidence: 99%

Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer

et al. 2012

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Background Our objective was to assess the risk factors for surgical site infections (SSIs) in gastric surgery using the results of the Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) 0501 phase 3 trial. Methods The OGSG 0501 trial was conducted to compare standard prophylactic antibiotic administration versus extended prophylactic antibiotic administration in 355 patients who underwent open distal gastrectomy for gastric cancer. Various risk factors associated with the incidence of SSI following gastrectomy were analyzed from the results of this multi-institutional randomized controlled trial. Results Among the 355 patients, there were 24 SSIs, for an overall SSI rate of 7 %. Multivariate analysis using eight baseline factors (administration of antibiotics, age, sex, body mass index [BMI], prognostic nutritional index, tumor stage, lymph node dissection, reconstructive method) identified that BMI C25 kg/m 2 was an independent risk factor for the occurrence of SSI (odds ratio 2.82; 95 % confidence interval [CI] 1.05-7.52; P = 0.049). BMI also showed significant relationships with the volume of blood loss and the operation time (P = 0.001 and P \ 0.001, respectively). Conclusion Compared with patients of normal weight, overweight patients had a significantly higher risk of SSI after distal gastrectomy for cancer.

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“…We should look to other specialties, such as general surgery, where obesity has not been shown to influence outcomes, 23,40 as well as emerging data from Europe, which suggests that post-RP oncological outcomes are equivalent across BMI groups. 16,17,25 For prostate cancer patients, it is certainly worthwhile to discuss the potential for increased risk, but to emphasize that recent data does not support a significant difference regarding complications and BCR.…”

Section: Discussionmentioning

confidence: 99%

Radical prostatectomy in obese patients: Improved surgical outcomes in recent years

et al. 2010

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Objectives: Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. Methods: Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25-30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. Results: Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown. Conclusion: As surgical experience with high BMI patients has developed , RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.

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Obesity in general elective surgery

Cited by 585 publications

References 25 publications

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer

Radical prostatectomy in obese patients: Improved surgical outcomes in recent years

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