Relationship of obesity to postoperative complications after cholecystectomy

The American Journal of Surgery (Impact Factor: 2.29). 02/1971; 121(1):87-90. DOI: 10.1016/0002-9610(71)90081-X
Source: PubMed


A study of 400 patients undergoing cholecystectomy between 1965 and 1969 was undertaken to determine the incidence of complications in obese and nonobese patients. The average complication rate is 42 per cent for female patients weighing less than 175 and 31 per cent for those over 175 pounds. Male patients weighing under 200 have a complication rate of 36 per cent compared to 28 per cent for those more than 200 pounds. There were no patients over 200 pounds who had postoperative cardiac arrhythmias, thrombophlebitis, pulmonary embolus, myocardial infarction, or stress ulcers, whereas several patients in each of the lower weight groups had two or more of these problems. Although obese patients present difficult technical problems, these results demonstrate that obesity per se is not associated with a higher postoperative morbidity or mortality in patients undergoing cholecystectomy.

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    • "Furthermore, a higher BMI is correlated with increased infection rates in trauma patients [55]. Compared with nonobese surgical patients, obese patients have an increased incidence of surgical complications, including atelectasis, thrombophlebitis, mortality, wound infection, and wound separation [3, 10, 19, 30–32, 34–39, 47, 48, 56–62]. Clearly, there is strong evidence indicating the association between obesity and poorer surgical outcomes, especially in relation to wound healing. "
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    ABSTRACT: Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population.
    02/2014; 2014(10):638936. DOI:10.1155/2014/638936
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    • "Postoperative pulmonary complication rate (%) Study Year Type of surgery Number of obese patients/ total number of patients Mean age (y) Definition of obesity Obese Non-obese Unadjusted relative risk Wightman [58] 1968 Noncardiac 149/785 NA NA 11 5 2.2 Pemberton [72] 1971 Cholecystectomy 66/400 NA a 11 20 0.6 Garibaldi [41] 1981 Thoracic and abdominal 62/520 NA >200 lb 23 18 1.3 Poe [60] 1988 Cholecystectomy 52/209 NA >120% ideal wt 12 16 0.8 Hall [17] 1991 Laparotomy 102/1000 54 BMI > 25 27 23 1.2 Calligaro [63] 1993 Aortic 26/128 68 >125% ideal wt 27 17 1.6 Phillips [73] 1994 Laparoscopic cholecystectomy 179/841 50 BMI > 30 0 0.5 0.0 Moulton [74] 1996 Cardiac 567/2299 62 BMI > 30 19 23 0.8 Thomas [32] 1997 Noncardiac 528/2964 67 BMI > 30 1.9 1.8 1.1 Brooks-Brunn [67] 1997 Abdominal 181/400 53 BMI > 27 29 17 1.7 Ranucci [75] 1999 CABG 116/345 63 BMI > 30 b 28 13 2.2 Perka [76] 2000 Total hip arthroplasty 120/229 65 BMI > 25 4 3 1.3 Benoist [77] 2000 Colectomy 158/584 65 BMI > 27 0.5 5.4 0.1 Total 2306/10,704 12 9 1.3 a males: >200 lb, females: >175 lb b Females: BMI > 28.6 "
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    ABSTRACT: Postoperative pulmonary complications in the elderly are common and are a significant source of morbidity, mortality, and prolonged length of stay. Risk factors differ from the well-known risk factors for cardiac complications and can be divided into patient- and procedure-related factors. Patient-related factors include COPD, recent cigarette use, poor general health status as defined by Goldman or ASA class, dependent functional status, and laboratory parameters including abnormal chest radiograph, renal insufficiency, and low serum albumin. Age is a minor risk factor when adjusted for comorbidities and confers approximately a two-fold increase in risk. Elderly patients who are otherwise acceptable surgical candidates should not be denied surgery based solely on age and concern for postoperative pulmonary complications. The surgical site is the single most important predictor of pulmonary complications. High-risk surgeries include thoracic, upper abdominal, aortic, neurosurgery, and peripheral vascular. Other procedure-related risk factors include surgery lasting longer than 3 hours, the use of general anesthesia, pancuronium use, and emergency surgery. Clinicians should not recommend routine preoperative spirometry before high-risk surgery because it is no more accurate in predicting risk than clinical evaluation. Patients who might benefit from preoperative spirometry include those who have unexplained dyspnea or exercise intolerance and those who have COPD or asthma in whom uncertainty exists as to the status of airflow obstruction when compared with baseline. After identifying patients at risk for postoperative pulmonary complications, clinicians can recommend strategies to reduce risk throughout the operative period. In addition to minimizing or avoiding the above risk factors, optimization of COPD or asthma, deep breathing exercises, incentive spirometry, and epidural local anesthetics reduce the risk of postoperative pulmonary complications in elderly surgical patients.
    Clinics in Geriatric Medicine 03/2003; 19(1):35-55. DOI:10.1016/S0749-0690(02)00051-4 · 1.83 Impact Factor
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    ABSTRACT: Summary Background: Overweight and obesity are associated with many complications. Their effects on operative morbidity and mortality in patients after open cholecystectomy have not been reported. Our objective was to report the results after open cholecys- tectomy of overweight and normal weight patients. Methods: We report surgical results of 50 consecutive patients who underwent open cholecystectomy in a rural hospital in Mexico during a 6-month period. Results: Fifty consecutive patients were included. Eighteen patients had a body mass index (BMI) 25). There were no significant differences in operative time (67 vs. 72 min), hospital stay (1.7 vs. 1.8 days) and postoperative complications (two in each group). The only significant difference that we found was a higher amount of surgical blood loss in overweight patients (148 vs. 94 ml, p
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