The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study

Fusco, Kellie; Thompson, Campbell; Woodman, Richard; Horwood, Chris; Hakendorf, Paul; Sharma, Yogesh

doi:10.3390/jcm10194382

Cited by 9 publications

(8 citation statements)

References 48 publications

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“…Furthermore, while propensity score analysis was used to address potential confounding factors and minimize bias, there may still be unmeasured confounding factors that could affect the outcomes. Unmeasured confounding may be evident in the current study wherein patients with and without morbid obesity demonstrated similar hospital and ICU lengths of stay, as well as similar durations of BL/BLI therapy, even though patients in the morbid obesity group had a significantly higher rate of presumed treatment failure, which differs from previous data [ 3 , 48 , 49 ]. Another possible limitation is our use of a composite endpoint to improve the ability to detect differences in the primary outcome between groups; however, we did report individual endpoints in the primary outcome for clarity and conducted a power analysis based on available data.…”

Section: Discussioncontrasting

confidence: 85%

Weighing the Odds: Novel β-Lactam/β-Lactamase Inhibitor Use in Hospital-Acquired and Ventilator-Associated Pseudomonas aeruginosa Pneumonia for Patients Who Are Morbidly Obese

Kunz Coyne,

Orzol,

Veve

et al. 2023

Open Forum Infectious Diseases

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Background Pseudomonas aeruginosa is a leading cause of hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP). Novel β-lactam/β-lactamase inhibitor (BL/BLI) combinations are often used for these infections; however, limited data exist to guide the dosing of BL/BLI in patients who are morbidly obese. Thus, we sought to evaluate the clinical and safety endpoints of patients who are morbidly obese (body mass index ≥35 kg/m2) and non–morbidly obese (<35 kg/m2) and receiving BL/BLI for P aeruginosa HABP/VABP. Methods This retrospective study was based on a cohort of patients hospitalized at 2 urban academic medical centers in Detroit, Michigan, from August 2014 through February 2021 with P aeruginosa HABP/VABP who were receiving BL/BLI (ceftazidime/avibactam, ceftolozane/tazobactam, or meropenem/vaborbactam) for ≥72 continuous hours. The primary endpoint was presumed treatment failure, defined as the presence of all-cause in-hospital mortality or the continuation of infectious symptoms. Analyses were adjusted for possible confounding with inverse probability of treatment weighting. Multivariable regression was used to identify predictors of treatment failure. Results In total, 285 patients with HABP (61.4%) and/or VABP (56.1%) were enrolled (morbidly obese, n = 95; non–morbidly obese, n = 190). The median Acute Physiology and Chronic Health Evaluation II score was 23 (IQR, 13–26), and 60% of patients were admitted to the intensive care unit at index culture collection. Patients who were morbidly obese demonstrated significantly greater odds of presumed treatment failure vs those who were non–morbidly obese (58.9% vs 37.9%, respectively; adjusted odds ratio, 1.675 [95% CI, 1.465–1.979]). In multivariable analysis, morbid obesity (1.06; 95% CI, 1.02–1.79), prolonged time to BL/BLI initiation (1.47; 95% CI, 1.28–2.66), renal dose–adjusted BL/BLI in the first 48 hours of therapy (1.12; 95% CI, 1.09–1.75), and continuous renal replacement therapy during BL/BLI therapy (1.35; 95% CI, 1.06–1.68) were independently associated with increased odds of presumed treatment failure. Conclusions Among hospitalized patients receiving BL/BLI for P aeruginosa HABP/VABP, those who were morbidly obese had significantly greater odds of presumed treatment failure when compared with those who were non–morbidly obese.

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Section: Discussioncontrasting

confidence: 85%

Weighing the Odds: Novel β-Lactam/β-Lactamase Inhibitor Use in Hospital-Acquired and Ventilator-Associated Pseudomonas aeruginosa Pneumonia for Patients Who Are Morbidly Obese

Kunz Coyne,

Orzol,

Veve

et al. 2023

Open Forum Infectious Diseases

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“…Although identification and management of undernutrition is an issue in hospitals, for many hospitalized patients addressing the nutrition problem of obesity will benefit health outcomes. Studies have found having morbid obesity leads to worse health outcomes, including longer lengths of hospital stays [ 12 , 13 , 15 , 17 ] and increased risk of hospital complications [ 17 , 18 , 41 ], including infection post-surgery [ 15 ]. In addition, patients who have obesity are more likely to be admitted to the Intensive Care Unit post-trauma [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, overweight and obesity contributed 8.4% to the burden of diseases, second only to tobacco use (9.3%). Obesity is associated with both greater duration and cost of hospitalization [ 11 ], with significant differences in the average length of stay found for almost all medical and surgical specialties for patients who have obesity [ 2 , 12 , 13 ]. Patients who have obesity have higher complications post-surgery [ 14 , 15 ], are at risk of skin breakdown and impaired wound healing [ 16 ], increased rates of infection and sepsis [ 11 , 15 , 17 , 18 ], have a greater chance of admission to the intensive care unit [ 17 ], and an increased risk of morbidity [ 18 ] and mortality [ 11 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting—A Point Prevalence Study

et al. 2023

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Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.

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“…En este estudio se encontró que casi el 25 % de los pacientes tenían un IMC por arriba de 25, siendo casi la mitad que, en otro estudio realizado en Paraguay ; y ligeramente inferior a otro, realizado en Perú. No obstante, otros estudios analíticos y metaanálisis no han encontrado una asociación entre la obesidad y la incidencia de ACV isquémicos (25)(26)(27)(28).…”

Section: Localización N (%)unclassified

Factores de riesgo para accidente cerebrovascular isquémico en pacientes internados en la Unidad de Ictus del Hospital de Clínicas, 2019-2023

Dure Romero,

Centurión-Wenninger,

Zárate

et al. 2024

ScientiAmericana

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Introducción: Este estudio tuvo como objetivo determinar los factores de riesgo de accidente cerebrovascular isquémico agudo en pacientes ingresados en la Unidad de Ictus del Hospital de Clínicas para comprender su impacto y la dependencia que genera una vez instaurada la enfermedad. Metodología: Se realizó un estudio observacional, descriptivo, transversal, retrospectivo, retrospectivo y descriptivo mediante muestreo no probabilístico aleatorizado simple por conveniencia. Se incluyeron pacientes con diagnóstico de accidente cerebrovascular isquémico agudo y la gravedad se evaluó mediante la Escala de Accidentes Cerebrovasculares de los Institutos Nacionales de Salud (NIHSS). Resultados: Se analizaron un total de 489 pacientes, con una NIHSS media de 7,29. Las manifestaciones clínicas más frecuentes incluyen alteraciones del lenguaje, alteraciones de la motilidad y alteraciones faciales. En los pacientes se observó una distribución de la frecuencia de la estenosis de los vasos del cuello, así como la localización más frecuente del ictus en la circulación anterior. Conclusiones: La hipertensión arterial fue el factor de riesgo más común afectando al 92,2% de los pacientes, seguida de diabetes mellitus (40,1%), tabaquismo (23,9%), obesidad (23,3%), fibrilación auricular (17,6%), dislipidemia (23,9%) y antecedentes de ictus previo (16,4%).

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The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study

Cited by 9 publications

References 48 publications

Weighing the Odds: Novel β-Lactam/β-Lactamase Inhibitor Use in Hospital-Acquired and Ventilator-Associated Pseudomonas aeruginosa Pneumonia for Patients Who Are Morbidly Obese

Weighing the Odds: Novel β-Lactam/β-Lactamase Inhibitor Use in Hospital-Acquired and Ventilator-Associated Pseudomonas aeruginosa Pneumonia for Patients Who Are Morbidly Obese

Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting—A Point Prevalence Study

Factores de riesgo para accidente cerebrovascular isquémico en pacientes internados en la Unidad de Ictus del Hospital de Clínicas, 2019-2023

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