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Drugs Jul 2019Morbid obesity (MO) is becoming increasingly prevalent worldwide and is associated with both altered physiology and increased co-morbidities. Together, these can render... (Review)
Review
Morbid obesity (MO) is becoming increasingly prevalent worldwide and is associated with both altered physiology and increased co-morbidities. Together, these can render the perioperative pain management in patients with MO particularly challenging. With the higher incidence of sleep-disordered breathing in this patient population, traditional opioid-centric pain management can often result in opioid-induced ventilatory impairment and increased morbidity and/or mortality. Multimodal analgesia strategies based on a step-wise, severity-based, opioid-sparing approach can improve patient safety and outcomes. These protocols should be standardized and implemented in the perioperative care of patients with MO. Further advancements in acute pain management have sought to identify and treat nociceptive and pro-nociceptive components (hyperalgesia, etc.) with both pharmacologic and non-pharmacologic measures. In addition to standardizing postoperative pain management, irrespective of the anesthetic and analgesic regimen used, some patients with MO will need extended monitoring for potential respiratory adverse events. In this review, we briefly describe the obesity-associated changes in physiology and their impact on the pharmacology of pain, and provide an evidence-based clinical update on the perioperative pain management in MO. We discuss the role of opioid-sparing pharmacological adjuvants and implementation of standardized protocols, and highlight future areas of research in perioperative pain management in this patient population.
Topics: Analgesia; Analgesics; Humans; Obesity, Morbid; Pain Management; Pain Measurement; Pain, Postoperative; Perioperative Care
PubMed: 31256367
DOI: 10.1007/s40265-019-01156-3 -
Obesity Surgery May 2021
Topics: History, 20th Century; Humans; Obesity, Morbid
PubMed: 33818690
DOI: 10.1007/s11695-021-05377-y -
The Surgical Clinics of North America Apr 2021Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand... (Review)
Review
Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand for bariatric/metabolic surgery worldwide. New procedures have been developed and changed the face of modern bariatric surgery. Gastrointestinal metabolic surgery is a new treatment modality for obesity-related type 2 diabetes mellitus for patients with body mass index greater than 35 kg/m. Providing safe bariatric/metabolic surgery, training qualified bariatric surgeons, and developing better techniques are important issues. This article discusses emerging procedures; a multitude of bariatric metabolic procedures enables surgeons to tailor treatment to patients' needs.
Topics: Bariatric Surgery; Humans; Obesity, Morbid; Treatment Outcome; Weight Loss
PubMed: 33743973
DOI: 10.1016/j.suc.2020.12.001 -
JBJS Reviews Apr 2023Obesity, defined as body mass index (BMI) ≥30, is a serious public health concern associated with an increased incidence of stroke, diabetes, mental illness, and... (Review)
Review
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Obesity, defined as body mass index (BMI) ≥30, is a serious public health concern associated with an increased incidence of stroke, diabetes, mental illness, and cardiovascular disease resulting in numerous preventable deaths yearly.
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From 1999 through 2018, the age-adjusted prevalence of morbid obesity (BMI ≥40) in US adults aged 20 years and older has risen steadily from 4.7% to 9.2%, with other estimates showing that most of the patients undergoing hip and knee replacement by 2029 will be obese (BMI ≥30) or morbidly obese (BMI ≥40).
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In patients undergoing total joint arthroplasty (TJA), morbid obesity (BMI ≥40) is associated with an increased risk of perioperative complications, including prosthetic joint infection and mechanical failure necessitating aseptic revision.
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The current literature on the role that bariatric weight loss surgery before TJA has on improving surgical outcomes is split and referral to a bariatric surgeon should be a shared-decision between patient and surgeon on a case-by-case basis.
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Despite the increased risk profile of TJA in the morbidly obese cohort, these patients consistently show improvement in pain and physical function postoperatively that should be considered when deciding for or against surgery.
Topics: Adult; Humans; Arthroplasty, Replacement, Knee; Bariatric Surgery; Diabetes Mellitus; Incidence; Obesity, Morbid
PubMed: 37098128
DOI: 10.2106/JBJS.RVW.22.00177 -
Obesity Surgery Jul 2023
Topics: Humans; Obesity, Morbid; Obesity; Bariatric Surgery
PubMed: 37423950
DOI: 10.1007/s11695-023-06662-8 -
Nefrologia 2020Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular... (Review)
Review
Various mechanisms are related to arterial hypertension in obesity. Central blood pressure (BP) seems to correlate more than peripheral BP with future cardiovascular risk. Bariatric surgery is an effective method to reduce BP along with weight loss in patients with morbid obesity. The study of the relationship between weight modification after bariatric surgery and ambulatory BP measurement, not only peripheral BP, but also central BP, could provide information regarding the mechanisms of organic damage associated with elevated BP in obesity. In this review we analyze the available evidence regarding the association between central BP with obesity and its modifications after bariatric surgery.
Topics: Albuminuria; Bariatric Surgery; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Body Mass Index; Circadian Rhythm; Cohort Studies; Comorbidity; Disease Susceptibility; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Meta-Analysis as Topic; Metabolic Syndrome; Obesity, Morbid; Prevalence; Randomized Controlled Trials as Topic; Weight Loss
PubMed: 31864863
DOI: 10.1016/j.nefro.2019.09.004 -
Scientific Reports Jan 2022Descriptions of the small intestinal microbiota are deficient and conflicting. We aimed to get a reliable description of the jejunal bacterial microbiota by...
Descriptions of the small intestinal microbiota are deficient and conflicting. We aimed to get a reliable description of the jejunal bacterial microbiota by investigating samples from two separate jejunal segments collected from the luminal mucosa during surgery. Sixty patients with morbid obesity selected for elective gastric bypass surgery were included in this survey. Samples collected by rubbing a swab against the mucosa of proximal and mid jejunal segments were characterized both quantitatively and qualitatively using a combination of microbial culture, a universal quantitative PCR and 16S deep sequencing. Within the inherent limitations of partial 16S sequencing, bacteria were assigned to the species level. By microbial culture, 53 patients (88.3%) had an estimated bacterial density of < 1600 cfu/ml in both segments whereof 31 (51.7%) were culture negative in both segments corresponding to a bacterial density below 160 cfu/ml. By quantitative PCR, 46 patients (76.7%) had less than 10 bacterial genomes/ml in both segments. The most abundant and frequently identified species by 16S deep sequencing were associated with the oral cavity, most often from the Streptococcus mitis group, the Streptococcus sanguinis group, Granulicatella adiacens/para-adiacens, the Schaalia odontolytica complex and Gemella haemolysans/taiwanensis. In general, few bacterial species were identified per sample and there was a low consistency both between the two investigated segments in each patient and between patients. The jejunal mucosa of fasting obese patients contains relatively few microorganisms and a core microbiota could not be established. The identified microbes are likely representatives of a transient microbiota and there is a high degree of overlap between the most frequently identified species in the jejunum and the recently described ileum core microbiota.
Topics: Adult; Aged; Bacteria; DNA, Bacterial; Female; Gastric Bypass; Gastrointestinal Microbiome; High-Throughput Nucleotide Sequencing; Humans; Intestinal Mucosa; Jejunum; Male; Middle Aged; Obesity, Morbid; Real-Time Polymerase Chain Reaction; Ribotyping; Young Adult
PubMed: 35102222
DOI: 10.1038/s41598-022-05723-9 -
Surgical Endoscopy Mar 2022The obesity rate is projected to reach 50% by 2030. Obesity may be modifiable prior to elective colorectal surgery, but there is no opportunity for weight loss when...
BACKGROUND
The obesity rate is projected to reach 50% by 2030. Obesity may be modifiable prior to elective colorectal surgery, but there is no opportunity for weight loss when patients present for urgent/emergency operations. The impact of obesity focused on urgent/emergent colorectal operations has not been fully characterized. The study aim was to determine outcomes of obese patients who undergo urgent/emergency colorectal surgery and differences when compared with elective outcomes.
METHODS
This is a retrospective cohort study of 30-day outcomes for normal (BMI 18.5-25), obese (BMI 30-39.9), and morbidly obese (BMI > 40) patients in the Michigan Surgical Quality Collaborative between 1/1/2009 and 12/31/2018. Propensity score weighting was used to derive adjusted rates for overall morbidity, mortality, and specific complications. Primary outcome was postoperative complications (any morbidity).
RESULTS
The study included 5268 urgent/emergency and 10,414 elective colorectal surgery patients. Postoperative complications were significantly more common in morbidly obese and obese than the normal BMI group for both urgent/emergency (morbidly obese 42.76% vs 33.75%, p = 0.003; obese 36.46% vs 33.75%, p = 0.043) and elective (morbidly obese 18.17% vs 13.36%, p = 0.004; obese 15.45% vs 13.36%, p = 0.011) operations. Surgical site infections are were significantly more common in morbidly obese and obese BMI groups as compared to normal BMI for both urgent/emergency and elective cases. Mortality was significantly higher in the morbidly obese (14.93% vs 11.44%, p = 0.013) but not obese BMI groups as compared to the normal BMI group for urgent/emergency cases. Mortality for all groups undergoing elective operations was < 1% and with no significant differences.
CONCLUSIONS
Morbid obesity and obesity are associated with complications that are largely driven by surgical site infections after both urgent/emergency and elective colorectal surgery. Obesity is a risk factor difficult to modify prior to urgent/emergency surgery. Managing complications related to obesity after colorectal surgery will be a continued challenge with projected increasing obesity rates.
Topics: Body Mass Index; Colorectal Neoplasms; Humans; Obesity, Morbid; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 33825018
DOI: 10.1007/s00464-021-08467-1 -
The Orthopedic Clinics of North America Jul 2023The prevalence of obesity in the United States is at a record high of 42%. In 1999, the Centers for Disease Control and Prevention recognized the obesity epidemic as a... (Review)
Review
The prevalence of obesity in the United States is at a record high of 42%. In 1999, the Centers for Disease Control and Prevention recognized the obesity epidemic as a national problem, spurring the first generation of interventions for obesity prevention and control. Despite billions of dollars in funding, legislative changes, and public health initiatives, the trajectory of American obesity has not waivered. Obesity is also strongly associated with the development of osteoarthritis. The growing population of young, obese, and sick patients presents a unique dilemma for orthopedic surgeons performing joint replacement, as obesity levels and the demand for joint replacement are only expected to rise further.
Topics: Humans; United States; Arthroplasty, Replacement, Knee; Obesity, Morbid; Osteoarthritis; Prevalence; Arthroplasty, Replacement; Arthroplasty, Replacement, Hip; Osteoarthritis, Knee
PubMed: 37271553
DOI: 10.1016/j.ocl.2023.02.010 -
The American Surgeon Jul 2022Bariatric surgery remains the most durable weight loss option to address morbid obesity, providing lasting reduction of debilitating chronic comorbidities. This is a... (Review)
Review
Bariatric surgery remains the most durable weight loss option to address morbid obesity, providing lasting reduction of debilitating chronic comorbidities. This is a review of the historical milestones that led up to the development of this surgical practice. We explore perceptions and interventions for obesity as early as the 10 century, as well as pre-modern surgical perceptions and advancements in foregut and obesity surgery. Additionally, we recount select social and surgical landmarks in the modern bariatric era. The aim of this review is to reflect on and appreciate the centuries of progress that have led to such an instrumental branch of risk reductive surgery.
Topics: Bariatric Surgery; Comorbidity; Humans; Lip; Obesity, Morbid; Treatment Outcome; Weight Loss
PubMed: 35333638
DOI: 10.1177/00031348221087400