Safety and efficacy of laparoscopic adjustable gastric banding in patients aged seventy and older

Abstract

BACKGROUND:

Life expectancy is increasing, with more elderly people categorized as obese. The objective of this study was to assess the effects of laparoscopic adjustable gastric banding (LAGB) on patients aged ≥70 years.

METHODS:

This was a retrospective analysis of patients aged ≥70 years who underwent LAGB at our university hospital between 2003 and 2011. The data included age, weight, body mass index (BMI), and percentage excess weight loss (%EWL) obtained before and after gastric banding. Operative data, length of stay, postoperative complications, and resolution of co-morbid conditions were also analyzed.

RESULTS:

Fifty-five patients aged ≥70 years (mean 73 years) underwent gastric banding between 2003 and 2012. Mean preoperative weight and BMI were 123 kilograms and 45 kg/m², respectively. On average, each patient had 4 co-morbidities preoperatively, with hypertension (n = 49; 86%), dyslipidemia (n = 40; 70%), and sleep apnea (n = 31; 54%) being the most common. Mean operating room (OR) time was 49 minutes, with all patients discharged within 24 hours. There was 1 death at 4 years from myocardial infarction, no intensive care unit admissions, and no 30-day readmissions. Mean %EWL at 1, 2, 3, 4, and 5 years was 36 (±12.7), 40 (±16.4), 42 (±19.2), 41 (±17.1), 50 (±14.9), and 48 (±22.6), respectively. Follow-up rates ranged from 55/55 (100%) at 6 months to 7/9 (78%) of eligible patients at 5 years and 2/2 (100%) at 8 years. Complications included 1 band slip at year 5, 1 band removed for intolerance, and 1 port site hernia. The resolution of hypertension, dyslipidemia, sleep apnea, lower back pain, and non-insulin-dependent diabetes was 27%, 28%, 35%, 31%, and 35%, respectively.

CONCLUSIONS:

LAGB as a primary treatment for obesity in carefully selected patients aged ≥70 can be well tolerated and effective with moderate resolution of co-morbid conditions and few complications.

Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Bariatric, Elderly, Gastric banding, Obesity, Safety

Perioperative characteristics and complications in obese patients undergoing anterior cervical fusion surgery

Abstract

In the USA, obesity rates have significantly increased in the last 15years. Mirroring this trend, a large proportion of patients undergoing spinal surgery are obese. Concern exists for increased complications due to surgical challenges posed by obese patients and their often-prevalent comorbidities. Studies have shown associations between body mass index (BMI) and perioperative complications in lumbar and thoracolumbar fusion surgeries; however, few studies have evaluated the impact of obesity on anterior cervical fusion surgery. As such, this study aimed to evaluate complications and perioperative characteristics in obese patients undergoing anterior cervical fusion. We queried medical records to identify patients with BMI >30 who underwent anterior cervical fusion surgery. A total of 69 patients were included and subdivided based on obesity class: Class 1 (BMI 30-35), Class 2 (BMI 35-40), and Class 3 (BMI >40). Subgroup analysis included comorbidities, diagnosis, procedure, levels treated, and length of hospital stay. Overall mean BMI was 35.1, mean age was 54.3years, and 43 (63.3%) were men. Disc herniation was the most common diagnosis. Length of stay differed significantly among obesity subgroups (p=0.02). Mean length of stay was 2.8, 3.5, and 4.0days for Classes 1, 2, and 3, respectively. Three (4.3%) complications were observed, comprising of urinary tract infection, wound dehiscence, and neck hematoma. Complication rates by class were 5.5%, 0%, and 16.6% for Classes 1, 2, and 3, respectively (p=0.17). We found that obese patients undergoing anterior cervical spine surgery experience relatively few complications. Hospital stay, however, appears to lengthen with increased BMI.

Copyright © 2013 Elsevier Ltd. All rights reserved.

KEYWORDS:

Cervical spine, Complications, Obesity, Surgery

Obesity as a Risk Factor for Sciatica: A Meta-Analysis

The aim of this study was to assess the associations of overweight and obesity with lumbarradicular pain and sciatica using a meta-analysis. We searched the PubMed, Embase, Scopus, and Web of Science databases from 1966 to July 2013. We performed a random-effects meta-analysis and assessed publication bias. We included 26 (8 cross-sectional, 7 case-control, and 11 cohort) studies. Both overweight (pooled odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.14, 1.33; n = 19,165) and obesity (OR = 1.40, 95% CI: 1.27, 1.55; n = 19,165) were associated with lumbar radicular pain. The pooled odds ratio for physician-diagnosed sciatica was 1.12 (95% CI: 1.04, 1.20; n = 109,724) for overweight and 1.31 (95% CI: 1.07, 1.62; n = 115,661) for obesity. Overweight (OR = 1.16, 95% CI: 1.09, 1.24; n = 358,328) and obesity (OR = 1.38, 95% CI: 1.23, 1.54; n = 358,328) were associated with increased risk of hospitalization for sciatica, and overweight/obesity was associated with increased risk of surgery for lumbar disc herniation (OR = 1.89, 95% CI: 1.25, 2.86; n = 73,982). Associations were similar for men and women and were independent of the design and quality of included studies. There was no evidence of publication bias. Our findings consistently showed that both overweight and obesity are risk factors for lumbar radicular pain and sciatica in men and women, with a dose-response relationship.

KEYWORDS:

back pain, hospitalization, intervertebral disc displacement, obesity, overweight, sciatica

Waist circumference and waist-to-hip ratio in carpal tunnel syndrome: A case-control study

The association between carpal tunnel syndrome (CTS) and high body mass index (BMI) and some hand measures is well known. No study has been specifically focused on waist circumference (WC) and waist-to-hip-ratio (WHR). The aim of this prospective case-control study is to evaluate the association between CTS and WC, WHR and other body and hand anthropometric measures.

METHODS:

We consecutively enrolled one "idiopathic" CTS case for two controls in 3 outpatient electromyography labs. The main anthropometric measures were BMI, WC, WHR, wrist ratio (WR) and hand ratio (HR). We performed univariate and multivariate analyses.

RESULTS:

Female cases and controls were 250 and 474 and male cases and controls were 120 and 273, respectively. At univariate analysis there were differences in many anthropometric measures between cases and controls. At multivariate logistic regression analyses high BMI, WC and WHR and abnormal HR and WR were independent risk factors for CTS. Crossing two categories between BMI, WC and WHR, the overweight subjects, especially females, were at risk only if they had very high WC or high WHR. The risk increased if they were obese.

CONCLUSIONS:

High WC/WHR doubles the risk of CTS, the risk further increased if overweight/obese subjects have also very high WC or high WHR. The obese subjects were always at risk regardless of WC and WHR values. Metabolic causes of this association with CTS were hypothesised. BMI is not the only and most powerful body predictor of "idiopathic" CTS, but also WHR and WC should be considered. These measures may not be interchangeable and it may be desirable to consider the utility of their joint use.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS:

Body mass index, Carpal tunnel syndrome, Hand ratio, Nerve entrapment syndrome, Obesity, Waist circumference, Waist-to-hip ratio, Wrist ratio

PMID:

 

24468538

 

[PubMed - as supplied by publisher]