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Morbid obesity perioperative care

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https://www.readbyqxmd.com/read/27837039/low-risk-for-local-and-systemic-complications-after-primary-repair-of-1626-achilles-tendon-ruptures
#1
Nicholas Rensing, Brian R Waterman, Rachel M Frank, Kenneth A Heida, Justin D Orr
INTRODUCTION: Historically, Achilles tendon repairs and other surgeries about the hindfoot have demonstrated a significantly higher rate of wound healing complications and surgical site morbidity. The purpose of this study was to evaluate the comprehensive complication profile and risk factors for adverse short-term, clinical outcomes after primary repair of Achilles tendon ruptures. METHODS: Between the years 2005 and 2014, all cases of primary Achilles tendon repair (Current Procedural Terminology code 27650) entered into the National Surgical Quality Improvement Project (NSQIP) database were extracted for analysis...
November 10, 2016: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/27770262/prior-bariatric-surgery-is-linked-to-improved-colorectal-cancer-surgery-outcomes-and-costs-a-propensity-matched-analysis
#2
Hisham Hussan, Peter P Stanich, Darrell M Gray, Somashekar G Krishna, Kyle Porter, Darwin L Conwell, Steven K Clinton
BACKGROUND: Morbid obesity is associated with worse colorectal cancer (CRC) perioperative outcomes. The impact of bariatric surgery on these outcomes is unknown. METHODS: The National Inpatient Sample Database (2006-2012) was used to identify adults with prior bariatric surgery (divided into BMI ≤35 kg/m(2) and BMI >35 kg/m(2)) or morbid obesity that underwent CRC surgery. Main outcomes were mortality, surgical complications and health care utilization. RESULTS: There were 1813 patients with prior bariatric surgery and 22,552 morbidly obese patients that underwent CRC surgery between 2006 and 2012...
October 21, 2016: Obesity Surgery
https://www.readbyqxmd.com/read/27759743/perioperative-and-periprocedural-airway-management-and-respiratory-safety-for-the-obese-patient-2016-siaarti-consensus
#3
Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27622571/perioperative-care-map-improves-compliance-with-best-practices-for-the-morbidly-obese
#4
Ian Solsky, Alex Edelstein, Michael Brodman, Ronald Kaleya, Meg Rosenblatt, Calie Santana, David L Feldman, Patricia Kischak, Donna Somerville, Santosh Mudiraj, I Michael Leitman, Peter Shamamian
BACKGROUND: Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients. METHODS: A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013...
December 2016: Surgery
https://www.readbyqxmd.com/read/27473800/laparoscopic-sleeve-gastrectomy-surgical-technique-and-perioperative-care
#5
REVIEW
Kellen Hayes, George Eid
Laparoscopic sleeve gastrectomy is a bariatric surgical procedure created for long-term weight loss and improvement of metabolic syndrome abnormalities in morbidly obese patients. It has been shown to demonstrate durable results compared with other bariatric procedures. This article aims to describe the surgical technique and perioperative care for patients undergoing laparoscopic sleeve gastrectomy based on current scientific literature and best standard practices.
August 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27347785/does-bmi-influence-hospital-stay-and-morbidity-after-fast-track-hip-and-knee-arthroplasty
#6
Henrik Husted, Christoffer C Jørgensen, Kirill Gromov, Henrik Kehlet
Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting...
October 2016: Acta Orthopaedica
https://www.readbyqxmd.com/read/27101501/perioperative-respiratory-adverse-events-in-pediatric-ambulatory-anesthesia-development-and-validation-of-a-risk-prediction-tool
#7
Rajeev Subramanyam, Samrat Yeramaneni, Mohamed Monir Hossain, Amy M Anneken, Anna M Varughese
BACKGROUND: Perioperative respiratory adverse events (PRAEs) are the most common cause of serious adverse events in children receiving anesthesia. Our primary aim of this study was to develop and validate a risk prediction tool for the occurrence of PRAE from the onset of anesthesia induction until discharge from the postanesthesia care unit in children younger than 18 years undergoing elective ambulatory anesthesia for surgery and radiology. The incidence of PRAE was studied. METHODS: We analyzed data from 19,059 patients from our department's quality improvement database...
May 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27049191/preventing-hospital-readmissions-and-limiting-the-complications-associated-with-total-joint-arthroplasty
#8
Stephen Yu, Kevin L Garvin, William L Healy, Vincent D Pellegrini, Richard Iorio
Total joint arthroplasty is a highly successful surgical procedure for patients who have painful arthritic joints. The increasing prevalence of total joint arthroplasty is generating substantial expenditures in the American healthcare system. Healthcare payers, specifically the Centers for Medicare and Medicaid Services, currently target total joint arthroplasty as an area for healthcare cost-savings initiatives, which has resulted in increased scrutiny surrounding orthopaedic care, health resource utilization, and hospital readmissions...
2016: Instructional Course Lectures
https://www.readbyqxmd.com/read/26948450/perioperative-noninvasive-ventilation-in-obese-patients-a-qualitative-review-and-meta-analysis
#9
REVIEW
Michele Carron, Francesco Zarantonello, Paola Tellaroli, Carlo Ori
BACKGROUND: Perioperative noninvasive ventilation (NIV) has been proposed to reduce postoperative morbidity and improve perioperative outcomes in patients undergoing general anesthesia. Whether it is advantageous to apply NIV just before and after general anesthesia in obese patients has not been yet established. OBJECTIVES: To perform a qualitative review and meta-analysis to assess the effectiveness and tolerability of perioperative NIV in obese patients. METHODS: All studies in English language performed in clinical setting that compared the application of NIV with standard care just before and after induction of general anesthesia in obese adults (body mass index [BMI]≥35 kg/m(2)) were included...
March 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/26804322/anesthetic-considerations-for-patients-with-bardet-biedl-syndrome-a-case-series-and-review-of-the-literature
#10
Bradford B Smith, David W Barbara, Joseph A Hyder, Mark M Smith
BACKGROUND: Bardet-Biedl syndrome (BBS) is a rare genetic condition with manifestations that can impact anesthetic and perioperative care. There is a void of literature describing the perioperative anesthetic management in this complex patient population. OBJECTIVES: The purpose of this retrospective series was to describe the perioperative care of patients diagnosed with BBS at a large academic tertiary referral center with experience in caring for these patients...
April 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/26658175/are-morbidly-obese-patients-suitable-for-ambulatory-surgery
#11
Tiffany Sun Moon, Girish P Joshi
PURPOSE OF REVIEW: The incidence of morbid obesity continues to increase worldwide. Associated comorbidities, particularly obstructive sleep apnea, increase the perioperative morbidity for this group of patients. The purpose of this review is to discuss appropriate selection of morbidly obese patients for ambulatory surgery. RECENT FINDINGS: Patients with BMI <40 kg/m can safely undergo ambulatory surgery, provided their comorbidities are optimized before surgery...
February 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/26645489/bariatric-surgery-in-1119-patients-with-preoperative-body-mass-index-35-kg-m-2-results-at-1-year
#12
Cristóbal Maiz, Juan Alvarado, Nicolás Quezada, José Salinas, Ricardo Funke, Camilo Boza
BACKGROUND: The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. OBJECTIVES: To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. SETTING: University hospital (censored). METHODS: A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011...
September 2015: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/26537879/negative-pressure-wound-therapy-for-high-risk-wounds-in-lower-extremity-revascularization-study-protocol-for-a-randomized-controlled-trial
#13
RANDOMIZED CONTROLLED TRIAL
Patrick Murphy, Kevin Lee, Luc Dubois, Guy DeRose, Thomas Forbes, Adam Power
BACKGROUND: Rates of surgical site infections (SSIs) following groin incision for femoral artery exposure are much higher than expected of a clean operation. The morbidity and mortality is high, particularly with the use of prosthetic grafts. The vascular surgery population is at an increased risk of SSIs related to peripheral vascular disease (PVD), diabetes, obesity, previous surgery and presence of tissue loss. Negative pressure wound therapy (NPWT) dressings have been used on primarily closed incisions to reduce surgical site infections in other surgical disciplines...
2015: Trials
https://www.readbyqxmd.com/read/26413219/liver-transplantation-and-sleeve-gastrectomy-in-the-medically-complicated-obese-new-challenges-on-the-horizon
#14
Diego C Reino, Keri E Weigle, Erik P Dutson, Adam S Bodzin, Keri E Lunsford, Ronald W Busuttil
In the last 30 years, operative, technical and medical advances have made liver transplantation (LT) a life-saving therapy that is used worldwide today. Global industrialization has been a contributor to morbid obesity and this has brought about the metabolic syndrome along with many downstream complications of such. Non-alcoholic steatohepatitis (NASH) has become a recognized hepatic manifestation of the metabolic syndrome and NASH cirrhosis is predicted to be the primary indication for LT in the United States by 2025...
September 28, 2015: World Journal of Hepatology
https://www.readbyqxmd.com/read/26371410/risk-factors-of-infected-sternal-wounds-versus-sterile-wound-dehiscence
#15
COMPARATIVE STUDY
Rose H Fu, Andrew L Weinstein, Michelle M Chang, Michael Argenziano, Jeffrey A Ascherman, Christine H Rohde
BACKGROUND: Sterile sternal dehiscence (SSD) and sternal wound infections (SWIs) are two complications of median sternotomy with high rates of morbidity. Sternal wound complications also carry significant economic burden, almost tripling patients' hospital costs and are considered a nonreimbursable "never event" for Medicare. Historically, SDD and SWI have been recognized as discrete entities, but nonetheless continue to be categorized as a singular complication in literature. The purpose of this study was to determine specific patient demographic and perioperative predictors of SSD and SWI...
January 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/26227518/bariatric-surgery-three-surgical-techniques-patient-care-risks-and-outcomes
#16
Carrie A McGraw, Daniel B Wool
The prevalence of obesity in the United States is a serious health concern. Bariatric surgery is a recognized and accepted approach for addressing weight loss and health conditions that occur as a result of morbid or severe obesity. Lifestyle changes, dietary modifications, and regular exercise are required for optimal and lasting surgical weight loss. Perioperative care of bariatric patients requires the use of interventions that differ from those used for nonobese patients, including bariatric-specific equipment, intraoperative monitoring of blood glucose, and postoperative monitoring for respiratory compromise...
August 2015: AORN Journal
https://www.readbyqxmd.com/read/26118917/perioperative-issues-and-sleep-disordered-breathing
#17
REVIEW
Karen L Wood, Beth Y Besecker
Sleep-disordered breathing in the perioperative setting poses an increase in both perceived and demonstrated challenges for health care providers. Some of these challenges relate to identifying patients at high risk for obstructive sleep apnea prior to surgery. Other management challenges include identifying the proper monitoring techniques, using the correct mix of pharmacologic and nonpharmacologic strategies to manage these patients, and identifying the proper and safe disposition strategy after surgery...
July 2015: Critical Care Clinics
https://www.readbyqxmd.com/read/26096563/assessment-of-postdischarge-complications-after-bariatric-surgery-a%C3%A2-national-surgical-quality-improvement-program-analysis
#18
Sophia Y Chen, Miloslawa Stem, Michael A Schweitzer, Thomas H Magnuson, Anne O Lidor
BACKGROUND: Little is reported about postdischarge complications after bariatric surgery. We sought to identify the rates of postdischarge complications, associated risk factors, and their influence on early hospital readmission. METHODS: Using the database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) (2005-2013), we identified patients ≥18 years of age who underwent a bariatric operation with a primary diagnosis of morbid/severe obesity and a body mass index ≥35...
September 2015: Surgery
https://www.readbyqxmd.com/read/26065222/-learning-curve-in-laparoscopic-roux-en-y-gastric-bypass-for-the-treatment-of-morbid-obesity
#19
Matan Ben David, Ilanit Maler, Hanoch Kashtan, Andrei Keidar
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently considered the gold standard treatment for morbid obesity. The learning curve for this procedure is about 100 cases, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB. METHODS: The data was collected prospectively. All patients with primary LRYGB between March 2006 and April 2014 were included. Only patients with full data on demographics, length of stay, operating time, and complications were included in the study...
April 2015: Harefuah
https://www.readbyqxmd.com/read/26059407/the-effect-of-body-mass-index-on-perioperative-outcomes-after-major-surgery-results-from-the-national-surgical-quality-improvement-program-acs-nsqip-2005-2011
#20
MULTICENTER STUDY
Akshay Sood, Firas Abdollah, Jesse D Sammon, Kaustav Majumder, Marianne Schmid, James O Peabody, Mark A Preston, Adam S Kibel, Mani Menon, Quoc-Dien Trinh
BACKGROUND: Obesity is associated with poor surgical outcomes and disparity in access-to-care. There is a lack of quality data on the effect of body mass index (BMI) on perioperative outcomes. Accordingly, we sought to determine the procedure specific, independent-effect of BMI on 30-day perioperative outcomes in patients undergoing major surgery. METHODS: Participants included individuals undergoing one of 16 major surgery (cardiovascular, orthopedic, oncologic; n = 141,802) recorded in the ACS-NSQIP (2005-2011)...
October 2015: World Journal of Surgery
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