Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient

Cooper, Lebron

doi:10.1155/2011/865634

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…Most likely, as a consequence of the previously mentioned effects of obesity on lung physiology, frequently associated respiratory comorbidities and increased risk of atelectasis, obese surgical patients have a greater risk of respiratory failure and other postoperative pulmonary complications [ 73 , 113 ]. Several general care recommendations in the postoperative care of obese surgical patients have been proposed to decrease the risk of atelectasis [ 68 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative lung protective ventilation in obese patients

et al. 2015

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The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8–15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity.

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Section: Introductionmentioning

confidence: 99%

Perioperative lung protective ventilation in obese patients

et al. 2015

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“…In contrast with this evidence, in a large prospective study on patients undergoing general surgery intervention, obesity was found to determine a mild increased risk of wound infection only, whereas the incidence of major events did not differ from normal weight patients [29]. Increased body weight has an important impact on the respiratory physiology: dynamic lung volumes are reduced [30], and atelectasis persists longer in morbidly obese patients [31], thus leading to a potential increased risk of pulmonary complications [32]. This effect has been confirmed in a surgical series of patients submitted to lung resection for several conditions: obese patients developed a higher increase in alveolar-arterial oxygen difference and hypoxia [33], even though clinically relevant consequences did not occur more frequently among obese patients.…”

Section: Discussionmentioning

confidence: 88%

The Role of Obesity in Early and Long-Term Outcomes after Surgical Excision of Lung Oligometastases from Colorectal Cancer

Londero

Parise

Grossi

et al. 2020

JCM

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Obesity correlates with better outcomes in many neoplastic conditions. The aim of this study was to assess its role in the prognosis and morbidity of patients submitted to resection of lung oligometastases from colorectal cancer. Seventy-six patients undergoing a first pulmonary metastasectomy were retrospectively included in the study. Seventeen (22.3%) were obese (body mass index (BMI) >30 kg/m2). Assessed outcomes were overall survival, time to recurrence, and incidence of post-operative complications. Median follow-up was 33 months (IQR 16–53). At follow-up, 37 patients (48.6%) died, whereas 39 (51.4%) were alive. A significant difference was found in the 3-year overall survival (obese 80% vs. non-obese 56.8%, p = 0.035). Competing risk analysis shows that the cumulative incidence of recurrence was not different between the two groups. Multivariate analysis reveals that the number of metastases (p = 0.028), post-operative pneumonia (p = 0.042), and DFS (p = 0.007) were significant predictors of death. Competing risk regression shows that no independent risk factor for recurrence has been identified. The complication rate was not different between the two groups (17.6% vs. 13.6%, p = 0.70). Obesity is a positive prognostic factor for survival after pulmonary metastasectomy for colorectal cancer. Overweight patients do not experience more post-operative complications. Our results need to be confirmed by large multicenter studies.

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“…Another notable finding in this study was the significantly higher incidence of VTE and PE complications with rib fixation. Both obesity and surgery are risk factors for the development of PE [24, 34]. In many cases, VTE prophylaxis is often held before or after a planned surgical procedure despite the fact that trauma patients are at an increased risk for VTE [35], [36, 37].…”

Section: Commentmentioning

confidence: 99%

Surgical Rib Fixation in Obese Patients with Isolated Flail Chest Improves Outcomes: A Matched Cohort Study

et al. 2022

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Background Obesity is associated with adverse outcomes after major operations. The role of operative rib fixation (RF) in obese patients with flail chest is not clear. The presence of other associated injuries may complicate the interpretation of outcomes. This study compared outcomes after RF to nonoperative management (NOM) in obese patients with isolated flail chest injury. Methods Adult obese patients (BMI > 29.9) with flail chest were identified from the Trauma Quality Improvement Program (TQIP) database (2016–2018). Hospital transfers, death within 72 h, and extrathoracic injuries were excluded. RF patients were propensity score matched (1:2) to similar NOM patients. Multivariate regression identified independent factors predicting adverse outcomes. Results Overall, 367 patients with isolated flail chest who underwent RF were matched with 734 in the NOM group. After matching, the mortality rate was significantly lower in the RF group (1.4% vs. 3.7%; p < 0.05). RF had longer HLOS (15.7 days vs. 12.8 days; p < 0.05) and ICU LOS (10.1 days vs. 8.6 days; p < 0.05), shorter ventilator days (9.2 days vs. 11.5 days; p < 0.05), and a higher rate of venous thromboembolism (7.1% vs. 3.5%, p < 0.05). On multivariate analysis, RF was associated with decreased mortality (OR 0.27; p < 0.05). Early RF (≤ 72 h) was associated with shorter ICU stay and mechanical ventilation. Conclusion RF for isolated flail chest in obese patients is associated with decreased mortality and fewer ventilator days. When performed early, fixation decreases the need for prolonged ventilator use and ICU stay. A more aggressive VTE prophylaxis should be considered in patients undergoing RF.

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Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient

Cited by 6 publications

References 35 publications

Perioperative lung protective ventilation in obese patients

Perioperative lung protective ventilation in obese patients

The Role of Obesity in Early and Long-Term Outcomes after Surgical Excision of Lung Oligometastases from Colorectal Cancer

Surgical Rib Fixation in Obese Patients with Isolated Flail Chest Improves Outcomes: A Matched Cohort Study

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