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ABSTRACT: Obesity is a risk factor for heart failure (HF), but the benefit of weight loss in HF is unknown. We assessed the effects of bariatric surgery (BSx) compared to non-operative treatment for morbid obesity on overall quality of life (QoL), functional capacity, and symptoms in 13 HF patients undergoing BSx and six HF patients treated without surgery. In the BSx group, median age was 62, body mass index (BMI) was 55 kg/m(2), and 5/13 were males; in the non-operative group, median age was 69, BMI was 42 kg/m(2), and 1/6 were male. Median follow-up was 4.3 and 2.7 years, respectively. At follow-up, BMI was less in the BSx group (35 vs 47 kg/m(2), p < 0.001); QoL (p < 0.01), frequency of exertional dyspnea (p = 0.01), and leg edema (p = 0.04) improved only in the BSx group. BSx induced weight loss and improved QoL and symptoms in morbidly obese patients with HF.
Obesity Surgery 04/2013; · 3.29 Impact Factor
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ABSTRACT: Bariatric surgery (BSx) produces clinically relevant weight loss that translates into improved quality of life, decreased mortality, and reduction in medical comorbidities, including cardiovascular (CV) risk. Little is known about patients' decision-making process to undergo BSx, but risk perception is known to influence medical decision-making. This study examined CV and BSx risk perception in obese subjects undergoing BSx (n = 268) versus those managed medically (MM) (n = 273). This retrospective population-based survey of subjects evaluated for BSx had 148 (55%) and 88 (32%) responders in the BSx and MM groups, respectively. Survey questions assessed risk perceptions and habits prior to weight loss intervention. CV risk was calculated using the Framingham Risk Score (FRS). At baseline, BSx subjects had a greater body mass index and greater prevalence of diabetes and depression. Follow-up mean weight loss was greater in the BSx group. BSx subjects perceived obesity as a greater risk to their overall health than the surgical risk. FRS declined in the BSx group (10 to 5%; p < 0.001) while there was no change in the MM group (8 to 8%; p = 0.54). Those without a measurable decrease in CV risk had a greater tendency to perceive the risk of BSx as greater than that of obesity. Obese subjects undergoing BSx are more likely than MM subjects to perceive obesity as a greater risk to their health than BSx. MM subjects generally underestimate their CV risk and overestimate the risk of BSx. Active discussion of CV risk using the FRS and the perception of risk associated with bariatric surgery can enhance patients' ability to make an informed decision regarding their management.
European journal of preventive cardiology. 11/2012;
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ABSTRACT: To assess the use and validity of prediction models to estimate the risk of cardiovascular disease (CVD) in Latin America and among Hispanic populations in the United States of America.
This was a systematic review of three databases: Ovid MEDLINE (1 January 1950-15 April 2010), LILACS (1 January 1988-15 April 2010), and EMBASE (1 January 1988-15 April 2010). MeSH search terms and domains were related to CVD, prediction rules, Latin America (including the Caribbean), and Hispanics in the United States. Database searches were supplemented by correspondence with experts in the field.
A total of 1 655 abstracts were identified, of which five cohorts with a total of 13 142 subjects met inclusion criteria. A Mexican cohort showed that the predicted/observed event-rate ratio for coronary heart disease (CHD) according to the Framingham risk score (FRS) was 1.68 (95% CI, 1.26-2.11); incident myocardial infarction, 1.36 (95% CI, 0.90-1.83); and CHD death, 1.21 (95% CI, 0.43-2.00). In Ecuador, a prediction model for CVD and total deaths in hypertensive patients had an area under the curve (AUC) of 0.79 (95% CI, 0.72-0.86), while the World Health Organization method had an AUC of 0.74 (95% CI, 0.67-0.82). A study predicting mortality risk in people with Chagas' disease had an AUC of 0.81 (95% CI, 0.72-0.90). Among a United State s cohort that included Hispanics, FRS overestimated CVD risk for Hispanics with an AUC of 0.69. Another study in the United States that assessed FRS factors predicting CVD death among Mexican-Americans had an AUC of 0.78.
The evidence regarding CVD risk prediction rules in Latin America or among Hispanics in the United States is modest at best. It is likely that the FRS overestimates CVD risk in Hispanics when not properly recalibrated.
Arquivos brasileiros de oftalmologia 08/2012; 32(2):131-9.
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ABSTRACT: We identified all total knee arthroplasty patients between 1996 and 2004 and classified them by preoperative body mass index (BMI) as normal (BMI, 18.5-24.9 kg/m(2)), overweight (BMI, 25.0-29.9 kg/m(2)), obese (30-34.9 kg/m(2)), or morbidly obese (≥ 35.0 kg/m(2)). Of 5521 patients, 769 had a normal BMI, 1938 were overweight, 1539 were obese, and 1275 were morbidly obese. Adjusted length of stay was no different between normal (4.85 days), overweight (4.84 days), obese (4.86 days), or morbidly obese patients (4.93 days) (P = .30). Overall costs were similar among normal ($15,386), overweight ($15,430), obese ($15,646), or morbidly obese patients ($15,752) (P = .24). Postsurgical costs were no different among normal ($9860), overweight ($9889), obese ($10,063), or morbidly obese patients ($10,136) (P = .44). Our results suggest that increased BMI does not lead to increased hospital resource use for total knee arthroplasty.
The Journal of arthroplasty 02/2010; 25(8):1250-7.e1. · 1.79 Impact Factor
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ABSTRACT: Cardiovascular disease is the most common cause of death and risk prediction formulae such as the Framingham Risk Score have been developed to easily identify patients at high risk that may require therapeutic interventions.
Using cardiovascular risk formulae at a population level to estimate and compare average cardiovascular risk among groups has been recently proposed as a way to facilitate surveillance of net cardiovascular risk and target public health interventions. Risk prediction formulas may help to compare interventions that cause effects of different magnitudes and directions in several cardiovascular risk factors, because these formulas assess the net change in risk using easily obtainable clinical variables. Because of conflicting data estimates of the incidence and prevalence of cardiovascular disease, risk prediction formulae may be a useful tool to estimate such risk at a population level.
Although risk prediction formulae were intended on guiding clinicians to individualized therapy, they also can be used to ascertain trends at a population-level, particularly in situations where changes in different cardiovascular risk factors over time have different magnitudes and directions. The efficacy of interventions that are proposed to reduce cardiovascular risk impacting more than one risk factor can be well assessed by these means.
BMC Medicine 01/2010; 8:29. · 6.03 Impact Factor
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ABSTRACT: Bariatric surgery leads to profound weight loss, but postoperative complications and psychosocial issues may impact long-term quality of life. The primary aim of this project was to examine whether such patients have better quality of life and self-reported functional status compared with obese adults who do not have bariatric surgery.
This population-based study of patients evaluated for Roux-en-Y gastric bypass surgery involved a survey consisting of baseline and follow-up single-item overall quality-of-life items (Linear Analogue Self-Assessment Questionnaire; LASA), follow-up quality of life (Short-Form-12), and activity (Goldman's Specific Activity Scale). A total of 268 and 273 surveys were mailed, with 148 (55.2%) operative and 88 (32.2%) nonoperative survey responders assessed, respectively. Linear regression was used, adjusting for changes in co-morbidity and functional status, to assess the differences in quality of life and activity level. Individual predictors of higher or better quality-of-life scores also were assessed.
There were no major differences in baseline characteristics between survey responders and nonresponders. Mean follow-up was 4.0 and 3.8 years in the operative and nonoperative groups, respectively. The change in overall LASA from baseline to follow-up between groups was 3.1 + or - 0.4 (P <.001). The adjusted Short-Form-12 score was 14.4 points higher in operative patients (P <.001) at follow-up. Operative patients had symptomatic improvement as measured by Specific Activity Scale status (odds ratio 7.5, P <.001) and self-reported exercise tolerance (odds ratio 2.61, P = .01) at follow-up compared with nonoperative patients. Predictors of a high follow-up LASA (P <.05) included initial treatment for depression, percent of weight lost, and absence of dyslipidemia and cardiovascular disease. Follow-up Short-Form-12 predictors included percent of weight loss, absence of baseline diabetes, baseline depression treatment, and follow-up cardiovascular disease.
Profound weight loss after bariatric surgery, seeking treatment for depression, and absence of medical co-morbidities appears to predict better quality of life and self-reported functional status.
The American journal of medicine 11/2009; 122(11):1055.e1-1055.e10. · 4.47 Impact Factor
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ABSTRACT: Obese patients are thought to be at higher risk of postoperative medical complications. We determined whether body mass index (BMI) is associated with postoperative in-hospital noncardiac complications following urgent hip fracture repair.
We conducted a population-based study of Olmsted County, Minnesota, residents operated on for hip fracture in 1988 to 2002. BMI was categorized as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (> or = 30 kg/m2). Postoperative inpatient noncardiac medical complications were assessed. Complication rates were estimated for each BMI category and overall rates were assessed using logistic regression modeling.
There were 184 (15.6%) underweight, 640 (54.2%) normal, 251 (21.3%) overweight, and 105 (8.9%) obese hip fracture repairs (mean age, 84.2 +/- 7.5 years; 80% female). After adjustment, the risk of developing an inpatient noncardiac complication for each BMI category, compared to normal BMI, was: underweight (odds ratio [OR], 1.33; 95% confidence interval [CI], 0.95-1.88; P = 0.10), overweight (OR, 1.01; 95% CI, 0.74-1.38; P = 0.95), and obese (OR, 1.28; 95% CI, 0.82-1.98; P = 0.27). Multivariate analysis demonstrated that an ASA status of III-V vs. I-II (OR, 1.84; 95% CI, 1.25-2.71; P = 0.002), a history of chronic obstructive pulmonary disease (COPD) or asthma (OR, 1.58; 95% CI, 1.18-2.12; P = 0.002), male sex (OR, 1.49; 95% CI, 1.10-2.02; P = 0.01), and older age (OR, 1.05; 95% CI, 1.03-1.06; P < 0.001) contributed to an increased risk of developing a postoperative noncardiac inpatient complication. Underweight patients had higher in-hospital mortality rates than normal BMI patients (9.3 vs. 4.4%; P = 0.01).
BMI has no significant influence on postoperative noncardiac medical complications in hip-fracture patients. These results attenuate concerns that obese or frail, underweight hip-fracture patients may be at higher risk postoperatively for inpatient complications.
Journal of Hospital Medicine 10/2009; 4(8):E1-9. · 1.40 Impact Factor
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ABSTRACT: There have been significant bidirectional changes in the prevalence of cardiovascular (CV) risk factors over time in the United States, making the net trend in risk for incident CV disease unknown. We assessed these trends by applying the Framingham Heart Study prediction model to national data.
The National Health and Nutrition Examination Survey (NHANES) II (1976-1980), NHANES III (1988-1994), and NHANES 1999-2004 are cross-sectional representative samples of the noninstitutionalized population of the United States. We excluded people with a history of CV disease, pregnant women, participants with missing CV risk factors data, and individuals outside the Framingham age range of 30 to 74 years. The Framingham risk function was used to estimate the 10-year risk for incident symptomatic CV disease. We calculated the slope of change or rate of change per year between NHANES II and III, and between NHANES III and 1999-2004. The difference between slopes was calculated and compared to zero. The average age-adjusted 10-year CV risk between NHANES II and III decreased from 10.0% to 7.9% between NHANES II and III, with a statistically significant slope (P<0.001). However, the average age-adjusted CV risk decreased at a lesser magnitude between NHANES III and NHANES 1999-2004 from 7.9% to 7.4% (P<0.001). These slopes were significantly different (P<0.0001). In women and middle-aged participants, CV risk did not change between NHANES III and NHANES 1999-2004 (P=0.40).
The estimated net risk for CV disease in the US population decreased from 1976-1980 to 1988-1994 but has changed minimally from 1988-1994 to 1999-2004, particularly in women and middle-aged people.
Circulation Cardiovascular Quality and Outcomes 09/2009; 2(5):443-50. · 4.91 Impact Factor
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ABSTRACT: Eating behaviors often predict outcomes after bariatric surgery, and in this regard, self-efficacy has been shown to predict long-term behavior. We examined current eating self-efficacy in post-bariatric surgery patients comparing them to obese non-surgery patients to determine whether weight loss is associated with increased self-efficacy in post-bariatric surgery patients.
We performed a population-based study of patients evaluated for Roux-en-Y gastric bypass and administered a survey using the Weight Efficacy Lifestyle (WEL) Questionnaire. There were 148 surgical and 88 non-operative patients who responded. Overall WEL score was assessed using linear regression models. Predictors of an increased self-efficacy score were also examined.
Follow-up was 4.0 and 3.8 years in the operative and non-operative groups, respectively. Operative responders were slightly older and had a lesser BMI compared to non-responders, otherwise the demographics were similar. Difference in overall WEL between groups was 25.5+/-5.3 points on a 0-180 scale. A 25% change in weight was associated with a difference of 15.4 points on the total WEL between groups. Current self-efficacy scores were highly related to weight loss and correlated to quality of life at follow-up (rho=0.36).
Profound weight loss after bariatric surgery is associated with increased eating self-efficacy in a population of obese adults seeking medical treatment for obesity.
Appetite 07/2009; 52(3):637-45. · 2.59 Impact Factor
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ABSTRACT: To determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).
A retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).
Mayo Clinic Rochester, a tertiary care centre.
Patients were stratified by pre-operative BMI as normal (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), obese (30.0-34.9 kg/m(2)) and morbidly obese (> or =35.0 kg/m(2)). Of 5642 patients, 1362 (24.1 %) patients had a normal BMI, 2146 (38.0 %) were overweight, 1342 (23.8 %) were obese and 792 (14.0 %) were morbidly obese.
Adjusted LOS was similar among normal (4.99 d), overweight (5.00 d), obese (5.02 d) and morbidly obese (5.17 d) patients (P = 0.20). Adjusted overall episode costs were no different (P = 0.23) between the groups of normal ($17,211), overweight ($17,462), obese ($17,195) and morbidly obese ($17,655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P = 0.03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P < 0.001). Post-operative costs were no different (P = 0.30). Blood bank costs differed (P = 0.002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P < 0.05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24.1 %) than normal (18.4 %), overweight (17.9 %) or obese (16.0 %) patients (P = 0.001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.
BMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.
Public Health Nutrition 03/2009; 12(8):1122-32. · 2.17 Impact Factor
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ABSTRACT: We retrospectively compared resource use of 2 groups of patients who underwent total hip arthroplasty between 1996 and 2004: those cared for on specialized orthopedic surgery (SOS) units and those cared for on nonorthopedic nursing (NON) units. Of 5546 patients, 5275 (95.1%) were admitted to SOS units and 271 (4.9%) to NON units. Mean overall adjusted cost saving for SOS patients was $622 (SD, $315; 95% CI, $3, $1241). Mean blood bank and room-and-board costs were lower on SOS units: $110 (SD, $36; 95% CI, $40, $181) and $298 (SD, $118; 95% CI, $66, $530), respectively. Difference in length of stay was not significant: mean, 0.19 day; SD, 0.11 day; 95% CI, -0.02 day, 0.40 day. Our results suggest that SOS units, as one way of optimizing patient flow in the postoperative period, may reduce unnecessary inpatients costs.
American journal of orthopedics (Belle Mead, N.J.) 02/2009; 38(1):E5-11.
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ABSTRACT: To determine whether obesity affects cardiac complications after hip fracture repair.
A population-based historical study using data from the Rochester Epidemiology Project.
Olmsted County, Minnesota.
All urgent hip fracture repairs between 1988 and 2002.
Body mass index (BMI) was categorized as underweight (<18.5 kg/m(2)), normal-weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (>or=30 kg/m(2)). Postoperative cardiac complications were defined as myocardial infarction, angina pectoris, congestive heart failure, or new-onset arrhythmias within 1-year of surgery. Incidence rates were estimated for each outcome, and overall cardiac complications were assessed using Cox proportional hazards models adjusted for age, sex, year of surgery, use of beta-blockers, and the Revised Cardiac Risk Index.
Hip fracture repairs were performed in 184 (15.6%) underweight, 640 (54.2%) normal-weight, 251 (21.3%) overweight, and 105 (8.9%) obese subjects (mean age 84.2 +/- 7.5; 80% female). Baseline American Society of Anesthesiologists (ASA) status was similar in all groups (ASA I/II vs III-V, P=.14). Underweight patients had a significantly higher risk of developing myocardial infarction (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.0-2.1; P=.05) and arrhythmias (OR=1.59, 95% CI=1.0-2.4; P=.04) than normal-weight patients. Multivariate analysis demonstrated that underweight patients had a higher risk of developing an adverse cardiac event of any type (OR=1.56, 95% CI=1.22-1.98; P<.001). Overweight and obese patients with hip fracture had no excess risk of any cardiac complication.
The obesity paradox and low functional reserve in underweight patients may influence the development of postoperative cardiac events in elderly people with hip fracture.
Journal of the American Geriatrics Society 02/2009; 57(3):419-26. · 3.74 Impact Factor
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ABSTRACT: Obese patients have an increased prevalence of cardiovascular (CV) risk factors, which improve with bariatric surgery, but whether bariatric surgery reduces long-term CV events remains ill defined. A systematic review of published research was conducted, and CV risk models were applied in a validation cohort previously published. A standardized MEDLINE search using terms associated with obesity, bariatric surgery, and CV risk factors identified 6 test studies. The validation cohort consisted of a population-based, historical cohort of 197 patients who underwent Roux-en-Y gastric bypass and 163 control patients, identified through the Rochester Epidemiology Project. Framingham and Prospective Cardiovascular Munster Heart Study (PROCAM) risk scores were applied to calculate 10-year CV risk. In the validation cohort, absolute 10-year Framingham risk score for CV events was lower at follow-up in the bariatric surgery group (7.0% to 3.5%, p <0.001) compared with controls (7.1% to 6.5%, p = 0.13), with an intergroup absolute difference in risk reduction of 3% (p <0.001). PROCAM risk in the bariatric surgery group decreased from 4.1% to 2.0% (p <0.001), whereas the control group exhibited only a modest decrease (4.4% to 3.8%, p = 0.08). Using mean data from the validation study, the trend and directionality in risk was similar in the Roux-en-Y group. The test studies confirmed the directionality of CV risk, with estimated relative risk reductions for bariatric surgery patients ranging from 18% to 79% using the Framingham risk score compared with 8% to 62% using the PROCAM risk score. In conclusion, bariatric surgery predicts long-term decreases in CV risk in obese patients.
The American Journal of Cardiology 10/2008; 102(7):930-7. · 3.37 Impact Factor
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ABSTRACT: To assess the effect of weight loss by bariatric surgery on the prevalence of the metabolic syndrome (MetS) and to examine predictors of MetS resolution.
We performed a population-based, retrospective study of patients evaluated for bariatric surgery between January 1, 1990, and December 31, 2003, who had MetS as defined by the American Heart Association/National Heart, Lung, and Blood Institute (increased triglycerides, low high-density lipoprotein, increased blood pressure, increased fasting glucose, and a measure of obesity). Of these patients, 180 underwent Roux-en-Y gastric bypass, and 157 were assessed in a weight-reduction program but did not undergo surgery. We determined the change in MetS prevalence and used logistic regression models to determine predictors of MetS resolution. Mean follow-up was 3.4 years.
In the surgical group, all MetS components improved, and medication use decreased. Nonsurgical patients showed improvements in high-density lipoprotein cholesterol levels. After bariatric surgery, the number of patients with MetS decreased from 156 (87%) of 180 patients to 53 (29%); of the 157 nonsurgical patients, MetS prevalence decreased from 133 patients (85%) to 117 (75%). A relative risk reduction of 0.59 (95% confidence interval [CI], 0.48-0.67; P<.001) was observed in patients who underwent bariatric surgery and had MetS at follow-up. The number needed to treat with surgery to resolve 1 case of MetS was 2.1. Results were similar after excluding patients with diabetes or cardiovascular disease or after using diagnostic criteria other than body mass index for MetS. Significant predictors of MetS resolution included a 5% loss in excess weight (odds ratio, 1.26; 95% CI, 1.19-1.34; P<.001) and diabetes mellitus (odds ratio, 0.32; 95% CI, 0.15-0.68; P=.003).
Roux-en-Y gastric bypass induces considerable and persistent improvement in MetS prevalence. Our results suggest that reversibility of MetS depends more on the amount of excess weight lost than on other parameters.
Mayo Clinic Proceedings 08/2008; 83(8):897-907. · 5.70 Impact Factor
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ABSTRACT: The use of specialized orthopedic surgery (SOS) units in total knee arthroplasty (TKA) patients is well established. The number and costs of arthoplasty surgeries continue to increase, requiring institutions to reexamine their existing practices for financial sustainability.
The objective of this study was to determine whether having elective TKA patients in SOS units affects resource utilization and outcomes.
The study was designed to retrospectively compare elective TKA patients from 1996 to 2004 admitted directly to SOS units with those admitted to nonorthopedic nursing (NON) units.
The setting was an academic teaching hospital.
Five thousand five hundred and thirty-four patients met inclusion criteria. Of these, 5082 (patients 91.8%) were admitted to SOS units and 452 (8.2%) to NON units.
The primary outcomes measured were length of stay (LOS) and costs, adjusted for age, sex, surgical year, comorbidities, and American Society of Anesthesiologists status. Secondary outcomes were 30-day mortality, readmissions, reoperations, and discharge disposition.
Mean age of the patients in SOS and NON units was 68.3 and 67.9 years, respectively (P = .50). Adjusted LOS was 0.234 days shorter in SOS units (95% CI: 0.083, 0.385). Adjusted total and hospital cost savings in the SOS unit group were $600 (95% CI: $122, $1079) and $594 (95% CI: $141, $1047), respectively. More NON-unit patients required unanticipated transfers to the intensive care unit (ICU) from the general postoperative nursing unit (3.1% vs. 1.63%; P = .023); however, the mean number of ICU days did not differ between groups. NON-unit patients were more likely to be discharged with home health care (P < .001). There were no differences in 30-day outcomes.
Patients on SOS units following elective TKA have a reduced LOS and decreased total and hospital costs. Our results should encourage hospitals to reevaluate postoperative patient flow to optimize resource utilization.
Journal of Hospital Medicine 06/2008; 3(3):218-27. · 1.40 Impact Factor
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ABSTRACT: We previously demonstrated that a hospitalist service created to medically manage patients with hip fracture reduced time to surgery and length of hospital stay, with no difference in inpatient mortality, compared with patients who received standard care. Whether this improved efficiency affects long-term mortality is unknown.
This study examined the effects of this hospitalist service versus standard care on mortality up to 1 year and identified predictors of mortality in patients with hip fracture.
Retrospective cohort study.
Tertiary care center.
Four hundred and sixty-six consecutive patients admitted for surgical repair of a hip fracture in 2000-2002 with 93% 1-year follow-up.
There was no significant difference in survival of the patients between those on the hospitalist care service and those on the standard care service (70.5% [CI: 64.8%, 76.7%] vs. 70.6% [CI: 64.9%, 76.8%]; P = .36), despite the shortened time to surgery and decreased length of stay in the hospitalist group. Predictors of mortality included: admission from a nursing home (hazard ratio [HR] 2.24, [CI: 1.73, 2.90]); age at admission (HR 1.17 [CI: 0.99, 1.38]); inpatient complications, including ICU admission, myocardial infarction, or acute renal failure (HR 1.85 [CI: 1.45, 2.35]); and ASA class III or IV compared with ASA class II (HR 4.20 [CI: 2.21, 7.99]).
The improved efficiency in reducing length of stay and time to surgery in the hospitalist group did not adversely affect long-term mortality of this patient population.
Journal of Hospital Medicine 08/2007; 2(4):219-25. · 1.40 Impact Factor
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Mayo Clinic Proceedings 05/2007; 82(4):448. · 5.70 Impact Factor
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ABSTRACT: Our goal was to assess the effect of bariatric surgery on cardiovascular risk estimations of preventable, long-term adverse outcomes.
We performed a population-based, historical cohort study between 1990 and 2003 of 197 consecutive patients from Olmsted County, MN, with Class II to III obesity (defined as BMI > or = 35 kg/m2) treated with Roux-en-Y gastric bypass and 163 non-operative patients assessed in a weight-reduction program. We used the observed change in cardiovascular risk factors and risk models derived from data from the National Health and Nutrition Examination Survey (NHANES) I and the NHANES I Epidemiological Follow-up Study (NHEFS) to calculate the predicted impact on cardiovascular events and mortality for the operative and non-operative groups.
Mean follow-up was 3.3 years. Hypertension, diabetes, and dyslipidemia all improved after bariatric surgery. The estimated 10-year risk for cardiovascular events for the operative group decreased from 37% at baseline to 18% at follow-up, while the estimated risk for the non-operative group did not change from 30% at baseline to 30% at follow-up. Risk modeling to predict 10-year outcomes estimated 4 overall deaths and 16 cardiovascular events prevented by bariatric surgery per 100 patients compared with the non-operative group.
Bariatric surgery induces an improvement in cardiovascular risk factors in patients with Class II to III obesity. Weight loss predicts a major, 10-year reduction in cardiovascular events and deaths. Bariatric surgery should be considered as an alternative approach to reduce cardiovascular risk in patients with Class II to III obesity.
Obesity 04/2007; 15(3):772-84. · 4.28 Impact Factor
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ABSTRACT: We present an unusual case of pancreatitis secondary to a polyp obstructing the papilla, treated endoscopically. A 45-year-old woman with familial adenomatous polyposis syndrome and prior total colectomy presented with acute pancreatitis. Upper endoscopy and endoscopic retrograde cholangiopancreaticogram revealed significant periampullary tissue. Sphincterotomy and endoscopic snare resection of the polyp were performed without complications. Local, noninvasive procedures are a promising diagnostic and therapeutic modality which has significantly less morbidity and mortality than conventional surgical techniques, and may be a reasonable alternative in the management of such patients.
Surgical laparoscopy, endoscopy & percutaneous techniques 03/2007; 17(1):45-8. · 1.23 Impact Factor
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ABSTRACT: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates that cause infective endocarditis in injection drug users (IDUs) are distinct from CA-MRSA strains that cause endocardial infection as a complication of skin and soft tissue infections. We present a case of CA-MRSA infective endocarditis, review pertinent cases previously published, and describe the molecular characteristics of strains from IDUs and patients with skin and soft tissue infections.
Scandinavian Journal of Infectious Diseases 02/2007; 39(4):299-302. · 1.72 Impact Factor
