Background The global burden of cardiovascular mortality is increasing, as is the number of large-scale humanitarian emergencies. The interaction between these phenomena is not well understood. This review aims to clarify the relationship between humanitarian emergencies and cardiovascular morbidity and mortality. Methods With assistance from a research librarian, electronic databases (PubMed, Scopus, CINAHL, Global Health) were searched in January 2014. Findings were supplemented by reviewing citations of included trials. Observational studies reporting the effect of natural disasters and conflict events on cardiovascular morbidity and mortality in adults since 1997 were included. Studies without a comparison group were not included. Double-data extraction was utilized to abstract information on acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), and cardiac death (SCD). Review Manager 5.0 was used to create figures for qualitative synthesis (Version 5.2, Copenhagen Denmark, The Nordic Cochrane Centre). Results The search retrieved 1697 unique records; 24 studies were included (17 studies of natural disasters, 7 studies of conflict). These studies involved 14,583 cardiac events. All studies utilized retrospective designs: 4 were population-based, 15 were single-center, and 5 were multicenter studies. 23 studies utilized historical controls in the primary analysis, and 1 utilized primarily geographical controls. Conflicts are associated with an increase in long-term morbidity from ACS; the short-term effects of conflict vary by study. Natural disasters exhibit heterogeneous effects including increased occurrence of ACS, ADHF, and SCD. Conclusions In certain settings, humanitarian emergencies are associated with increased cardiac morbidity and mortality that may persist for years following the event. Humanitarian aid organizations should consider morbidity from non-communicable disease when planning relief and recuperation projects.

No abstract

Objective To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery. Study Design Retrospective cohort study. Setting Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018. Methods The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression. Results Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P < .001), rate of diabetes (18.2% vs 7.2%, P < .001), and rate of hypertension requiring medication (43.1% vs 23.0%, P < .001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P = .02) and have disseminated cancer (<1% vs 3.2%, P < .001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P = .027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P = .022). There was no statistical difference in medical complications ( P = .775), unplanned readmissions ( P = .286), unplanned reoperations ( P = .053), or 30-day mortality ( P > .999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968). Conclusion Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.