Background Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion. Objective To evaluate the impact of obesity on resource utilization and early complications in patients undergoing surgery for degenerative spine disease. Methods A single institution retrospective analysis was conducted on degenerative spine disease patients requiring instrumentation, between 2008 and 2012. The 801 identified patients were grouped based on a body mass index (BMI) of < 30 (non-obese, n=478), ≥ 30 and < 40 (obese, n=283), and alternatively BMIs of ≥ 40 (morbidly obese, n=40). Baseline characteristics, surgical outcomes and requirements, complications, and cost were compared. Logistic and linear regression analyses were used to determine the strength of association between obesity and outcomes for categorical and continuous data, respectively. Results Significant differences were found in co-morbidities between cohorts. Multivariate analysis revealed significant associations between obesity and longer anesthesia times (30 min, p=.008), and surgical times (24 min, p=.02). Additionally, there was a 2.8 times higher rate of wound complications in obese patients (4.2% vs. 1.5, p=.03), and 2.5 times higher rate of major medical complications (7.8% vs. 3.1, p=.01). Morbid obesity resulted in a 10 times higher rate of wound complications (p<.001). Morbid obesity resulted in a $9,078 (p=.005) increase in overall cost of care. Conclusion Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of co-morbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.
The clinical significance of cerebral microbleeds (CMB) in patients hospitalized with atrial fibrillation (AF) and cerebral ischemia is unclear. We aimed to determine the prevalence of CMB in this population and determine the future risk of intracerebral hemorrhage (ICH) and cerebral infarction (CI). The medical records and brain imaging of patients hospitalized with cerebral ischemia due to AF between 2008 and 2011 were reviewed. Followup was obtained through medical record review, mailed survey, and acquisition of death certificates. Prevalence was calculated from those patients with a hemosiderin-sensitive MRI sequence. Recurrent CI and ICH were calculated using Kaplan-Meier curves censored at 3 years. Among 426 patients hospitalized with cerebral ischemia due to AF, 134 had an MRI with hemosiderin-sensitive sequences. The prevalence of CMB was 27.6%. At 3 years, 90.6% of CMB-negative patients were overall stroke free (ICH and CI) compared to 78.6% CMB-positive patients (p = 0.0591). Only one patient in the CMB-positive group had an ICH distant to the CMB. There was a nonsignificant trend toward higher recurrent CI, recurrent overall stroke rate, and mortality in patients with 5 or more CMB compared to 0-4 CMB. The rate of prospective CI in patients with prior cerebral ischemia due to AF is higher than the rate of ICH in patients with CMB. Further study is warranted to assess larger numbers of patients to determine appropriate antithrombotic use in this high-risk population.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.