The risks of surgery in obese patients.
ABSTRACT Obesity is commonly considered a surgical risk factor, but the degree of risk has been imprecisely quantified. There is little evidence that excessive body weight in itself should contraindicate general surgery. However, obesity is often associated with abnormal cardiorespiratory function, metabolic function, and hemostasis, which may predispose to morbidity and mortality after surgery. We review pertinent data and offer guidelines to minimize the risks of surgery in obese patients.
Official journal of the South African Academy of Family Practice/Primary Care 08/2014; 54(3):193-197. DOI:10.1080/20786204.2012.10874214
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ABSTRACT: Patient- and procedure-related factors associated with postoperative pulmonary complications (PPCs) have changed over the last decade. Therefore, we sought to identify independent risk factors of PPCs and to develop a clinically applicable scoring system. We retrospectively analyzed clinical data from 2,059 patients who received preoperative evaluations from respiratory physicians between June 2011 and October 2012. A new scoring system for estimating PPCs was developed using beta coefficients of the final multiple regression models. Of the 2,059 patients studied, 140 (6.8%) had PPCs. A multiple logistic regression model revealed seven independent risk factors (with scores in parentheses): age ≥70 years (2 points), current smoker (1 point), the presence of airflow limitation (1 point), American Society of Anesthesiologists class ≥2 (1 point), serum albumin <4 g/dL (1 point), emergency surgery (2 points), and non-laparoscopic abdominal/cardiac/aortic aneurysm repair surgery (4 points). The area under the curve was 0.79 (95% CI, 0.75-0.83) with the newly developed model. The new risk stratification including laparoscopic surgery has a good discriminative ability for estimating PPCs in our study cohort. Further research is needed to validate this new prediction rule.PLoS ONE 12/2014; 9(12):e113656. DOI:10.1371/journal.pone.0113656 · 3.53 Impact Factor