This single-center retrospective observational study aimed to determine whether obesity is associated with postoperative flap complications following maxillofacial reconstruction. Obesity can increase the risk of postoperative flap complications during autologous breast reconstruction. Therefore, we hypothesized that obesity also affects maxillofacial reconstruction.

A total of 338 patients (140 males and 198 females) who underwent maxillofacial reconstruction between January 2016 and December 2021 were included. The primary outcome variable was the occurrence of complications. The patients were divided into two groups according to the presence or absence of complications at the recipient site, and risk factors were compared between the two groups. A univariable and multivariable logistic regression analysis was used to investigate the associations between the predictors and outcomes.

Twenty-five (7.40%) of the 338 patients experienced free-flap complications. Those with a greater body mass index (BMI > 25) had the highest complication incidences (13.33%). The multivariable logistic regression analysis showed a higher flap complication risk among patients with obesity than among those with a normal BMI (odds ratio, 3.178; 95% confidence interval: 1.073-9.415, P = .037).

There was a clear association between BMIs > 25 and flap complication after maxillofacial reconstruction.

A significant proportion of patients that undergo primary sleeve gastrectomy (SG) require revision or conversion metabolic and bariatric surgery (MBS). Despite various procedures performed in practice, comparative analyses of short-term outcomes remain limited.

We conducted a retrospective comparative analysis of postoperative outcomes of revision or conversion MBS following primary SG.

The 2020-2022 MBSAQIP database.

We included patients who underwent any one of the following: revision SG (Re-SG), Roux-en-Y gastric bypass (SG-RYGB), biliopancreatic diversion/duodenal switch (SG-BPD/DS), single anastomosis duodenoileal bypass (SG-SADI), or one anastomosis gastric bypass (SG-OAGB). Our primary outcome was 30-day major complications, defined as Clavien-Dindo Grade≥ II.

Among 33,348 revision/conversion MBS, SG-RYGB was the most common (n = 27,393, 82.1%). Compared to SG-RYGB, the odds of 30-day major complications were lower in Re-SG (odds ratio [OR] .75, 95%- confidence interval [CI] .61-.90) and SG-SADI (OR .75, 95%-CI .57 - .97). However, both Re-SG and SG-SADI were associated with higher odds of anastomotic or staple line leak (OR 2.74; 95%-CI 1.78-4.12 and OR 2.44; 95%-CI 1.35-4.17, respectively). In addition, both Re-SG (mean difference 1.66 days, 95%-CI .44 - 2.88) and SG-SADI (MD 3.0 days, 95%-CI 1.31- 4.70) resulted in longer hospital stays upon readmission.

In our analysis, Re-SG and SG-SADI had lower odds of 30-day major complications compared to SG-RYGB, but had significantly higher odds of anastomotic or staple line leak and had longer hospital stays on readmission. Given its limited indications and significant potential morbidity, Re-SG should not be routinely offered as a revisional procedure for primary SG.

Background  Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS. Methods  Patient data from 2015 to 2020 were obtained from the American College of Surgeons-National Surgical Quality Improvement Program database and were included in this study if they had a procedure corresponding to an MVD with the current procedural terminology code 61458. Patient demographics, comorbidities, and outcomes were analyzed. Patients were subsequently categorized based on body mass index (BMI) and a logistic regression analysis was used to model the association of comorbidities with reoperation and its indication. Results  The overall rate of reoperation in the cohort is 3.2 and 7.2% for patients with morbid obesity (BMI ≥ 40; p  = 0.006). Patients with morbid obesity were more likely to present at a younger age (50.1 vs. 57.4; p  < 0.0001), have comorbidities such as hypertension (60.9 vs. 33.5%; p  < 0.0001) and diabetes (16.3 vs. 7.7%; p  = 0.0002), and increased procedure duration (179 vs. 164 minutes; p  = 0.02). Indications for reoperation include cerebrospinal fluid (CSF) leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. Conclusion  We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reoperation.

Textbook outcome (TO) has been utilized to assess the quality of surgical care. This study aimed to define TO rates for minimally invasive gastric gastrointestinal stromal tumor (GIST) resections in a bi-institutional cohort.

Patients with gastric GIST (≤ 5 cm) who underwent laparoscopic or robotic resection (January 2014 to January 2024) were retrospectively identified from two GIST centers. We excluded patients with concurrent procedures, tumor involvement of adjacent organs, or metastatic disease. To balance perioperative and oncologic outcomes, we defined TO as: R0 resection, no conversion to open surgery, operative time ≤ 120 min, no perioperative transfusions, no intraoperative complications, no Clavien-Dindo ≥ II complications, hospital length of stay (LOS) ≤ 3 days, no 90-day readmission or death, no tumor rupture, and recurrence-free status at 2 years (5% predicted recurrence risk for tumors with a low mitotic index).

A total of 83 patients were included. TO was achieved in 62.7% of cases (N = 52). Mean tumor size was 3.0 ± 1.0 cm and 86.7% of GIST were modified-NIH low or very low risk (i.e., mitotic index ≤5/mm2). Mean operative time was 102.7 ± 49.3 minutes. Mean LOS was 2.3 ± 1.2 days. Among non-TO cases, the most common disqualifying factors were operative time > 120 minutes (N = 20, 24.1%) and LOS > 3 days (N = 15, 18.1%). There were four 90-day readmissions (4.8%) and one case with staple line bleeding requiring endoscopic clipping. During a mean follow-up of 32.6 ± 24.1 months, 3 patients (3.6%) recurred within 2 years. On multivariable regression analysis, no factors were independently associated with non-TO.

Minimally invasive gastric GIST resection is well-described. Herein, we propose new TO standards to serve as a measure of short- and long-term outcomes for monitoring institutional performance.

The use of drains in reduction mammoplasty is highly variable among plastic surgeons. However, there is limited evidence to guide surgeons on the optimal timing and conditions for using drains to reduce the risk of seroma formation. The objective of this study was to identify factors that predict the possibility of developing postoperative seroma formation.

Retrospective review of patients who underwent bilateral reduction mammoplasty without intraoperative drain placement at our institution between January 2016 and July 2021 was performed. Demographics, clinical characteristics, and the rate of seroma that required aspiration or drainage were recorded. Univariate time-to-event analyses using Cox regression were performed to identify the predictors of seroma.

A total of 234 patients (468 breasts) were included. The mean age, body mass index, and resection weight were 40.9±17.6 months; 30.7±5.5 kg/m2, and 717.2±388 g, respectively. The superomedial pedicle was used in 268 (57.3%) breast reductions while the inferior pedicle was used in 200 (42.7%) cases. Median follow-up time was 3.2 months (IQR: 2.8 months). Seromas occurred in 17 breasts (3.6%). Patients who were of World Health Organization Obesity Class I (hazards ratio, HR = 15.5, p = 0.01), Class II (HR = 13.9, p = 0.016), and Class III (HR = 27.4, p = 0.004) had increased risk for developing seroma when compared to non-obese patients.

The rate of seroma formation was 3.6% in this cohort. Obesity significantly increased the risk of postoperative seroma formation that required aspiration or surgical drainage; therefore, surgeons who aim to further reduce the risk of seroma should consider using drains for these patients.

Increased perioperative complications in obese patients undergoing total hip arthroplasty (THA) have previously been reported. There is a relative paucity of data evaluating these complications strictly in the context of anterior-based THA. In this study, we compare the outcomes following anterior-based THA as a function of body mass index (BMI).

A 1:1 matched retrospective cohort study was conducted. Patients undergoing anterior-based THA from January 2022 to June 2024 with a BMI >35 kg/m2 were matched 1:1 based on age and sex to patients with a BMI <35 kg/m2 from our division registry. Demographic data, surgical details, complications (intraoperative and postoperative), and patient-reported outcome measures (PROMs: 12-Item Short Form P/M, Western Ontario and McMaster Universities Osteoarthritis Index-P/S/F) were collected and analyzed.

There were 280 patients included (140 per group). There were 27 postoperative complications in the BMI >35 kg/m2 group and 10 in the BMI <35 kg/m2 group (P < .01). There were 10 major complications (4 dislocations, 2 periprosthetic fractures, and 4 deep infections requiring incision and drainage) in the BMI over 35 kg/m2 group, with no major complications occurring in the lower BMI group. There were 3 intraoperative complications (periprosthetic fracture), all in patients with BMI >35 kg/m2. There was significant improvement in Western Ontario and McMaster Universities Osteoarthritis Index P/S/F scores and 12-Item Short Form pain in both groups at 3 months postoperatively, with greater improvements seen in the BMI >35 kg/m2 group.

The present study found that despite significant differences in postoperative complications, there were significant improvements in PROMs in patients with a BMI above and below 35 kg/m2 who underwent anterior THA.

The surgical patient with obesity presents several challenges in intraoperative and postoperative care. We designed this cross-sectional survey to assess surgeon willingness to prescribe preoperative very low energy diets (VLEDs) and practice patterns in prescribing preoperative weight loss interventions for patients with obesity undergoing non-bariatric abdominal surgery.

We conducted a cross-sectional survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery, reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies and utilizing non-probability convenience sampling. The primary outcome was willingness to prescribe preoperative VLED to obese patients undergoing major non-bariatric abdominal surgery for both benign and malignant indications. We created a multivariable proportional odds model to identify factors associated with willingness to prescribe VLEDs. A total of 78 participants completed and returned the survey (response rate 10.9%; mean age 43.54 ± 8.13 years; 48.72% female). Most surgeons (79.5%) felt that obesity significantly impacted the technical difficulty of their operations. We identified a disconnect between those surgeons who were willing prescribe VLEDs vs. those who actually prescribed them (78.2% vs. 30.8%, respectively). Approximately half of the surgeons reported being unfamiliar with VLEDs. Regression analysis identified practicing in academic institutions was associated with increased willingness to prescribe [odds ratio (OR) 3.71, 95% confidence intervals (CI) 1.01-13.7, p < 0.01].

Although the majority of surgeons feel that obesity adversely impacts perioperative care, only one-third routinely discuss preoperative VLEDs with their patients. Opportunities to increase awareness and evaluate the impact of VLEDs on patient outcomes remain high.

We examined the association of risk factors with socioeconomic deprivation in patients waiting for high volume low complexity (HVLC) surgical procedures in the North East and North Cumbria region.

We analysed data from the Rapid Actionable Insight Driving Reform database which links primary and secondary care elective waiting list data.

Patients were included if they were waiting for HVLC surgery or an initial outpatient appointment for HVLC surgery.

Smoking status, living with obesity, type 2 diabetes mellitus (T2DM), atrial fibrillation, chronic obstructive pulmonary disease (COPD), hypertension, serious mental illness or learning disability. Differences in outcomes by the England Index of Multiple Deprivation score quintiles were examined using ORs (95% CI).

Of 78 571 patients, 30.6% were living in the most deprived quintile, 29.4% were living with obesity, 28.9% had hypertension and 13.5% were smokers. Though younger, 64.2% of patients in the most deprived quintile had at least one risk factor compared with 48% of patients in the least deprived quintile (OR 1.9 (95% CI 1.9, 2.0). The odds of being a smoker, living with obesity, T2DM, COPD and a serious mental illness or learning disability decreased as deprivation decreased in a dose-response relationship.

People waiting for surgery from areas of greater deprivation are living with significantly more risk factors, and this may impact eligibility for surgery and surgical outcomes. Perioperative service provision must be delivered with deprivation in mind, otherwise health inequalities will be amplified.

With obesity, the post-operative period is characterized by an increased and prolonged inflammatory response. This study evaluated the impact of obesity on postpartum recovery after elective cesarean delivery, using the Obstetric Quality of Recovery Score-10 (ObsQoR-10).

A prospective observational cohort study was conducted with 127 patients divided into two groups: Control (BMI <30) and High BMI (BMI >40 kg/m²). All patients received standardized care, including spinal anesthesia and multimodal analgesia. The primary outcome was the difference in ObsQoR-10 scores between the two groups 24 hours after surgery. Secondary outcomes included pain scores, total opioid consumption, incidence of adverse events, time to first mobilization, length of hospital stay, breastfeeding rates, and readmission rates.

Median (interquartile range) ObsQoR-10 scores at 24 hours were 83 (73.5-90.5) versus 82 (70-90) for the control group and the High BMI group, respectively. There were no significant differences in median 24-hour opioid consumption (0, 0 to 10, P=.078) between groups and in the median Numeric Rating Score for pain at 24 hours (0, -1 to 1) at rest (P=0.97) and on movement (P=0.78). There were no differences in length of stay or hospital readmission rates, however patients in the obesity group tended to breastfeed less and mobilize earlier than patients in the control group.

This study suggests minimal differences in the quality of recovery between the two groups. Future studies should examine recovery in patients with BMI >50, beyond 24 hours, and post-discharge.

In USA, total shoulder arthroplasty (TSA) ranks amongst the top five surgeries that require hospitalization. As a result, the healthcare system in USA could face a considerable financial strain due to the emergence of subsequent pulmonary problems. This study aimed to conduct a thorough examination of the prevalence, influential factors and medical importance of pulmonary complications, with emphasis on pneumonia, respiratory failure and pulmonary embolism (PE) following total shoulder arthroplasty (TSA) procedures in USA.

The National Inpatient Sample (NIS) was utilized to survey all patients who underwent primary elective TSA from 2010 to 2019. Pneumonia, respiratory failure and PE following TSA were considered to be pulmonary consequences. The inpatient expenses, length of hospitalization, death rates and patient characteristics of those with and without reported perioperative pulmonary problems were compared. The utilization of trend weights was necessary to obtain incidence estimates across USA, considering the stratified framework of the NIS database and the dependence on observed frequencies within the database. Two assessments were utilized to assess the projected annual rates of complications.

Between 2010 and 2019, a total of 189,695 patients were estimated to underwent primary elective TSA. Infections, such as pneumonia, respiratory failure or PE, complicated 1.4% (95% CI, 1.52%-1.64%) of TSA operations. The ailments at this period that were most likely to result in pulmonary problems were ulcer (adjusted odds ratio [AOR] = 9.43; 95% CI, 4.99-46.91), pulmonary circulation disorders (AOR = 9.01; 95% CI, 4.56- 31.92), weight loss (AOR = 4.84; 95% CI, 2.15-10.88), fluid and electrolyte disorders (AOR = 3.55; 95% CI, 2.55-4.95), alcohol abuse (AOR = 1.56; 95% CI, 1.08-2.26), congestive heart failure (AOR = 3.09; 95% CI, 1.83-5.24), chronic pulmonary disease (AOR = 2.45; 95% CI, 1.60-3.75), deficiency anaemia (AOR = 1.56; 95% CI, 1.08-2.26), depression (AOR = 1.47; 95% CI, 1.03-2.11) and obesity (AOR = 1.46; 95% CI, 1.01-2.11). A correlation was found between perioperative pulmonary problems and extended LOS (+ 3 days; 95% CI, 2-6) and increased hospitalization costs (= + 20,514 US dollars; 95% CI, 14,109-35,281).

This investigation primarily aimed to ascertain potential risk factors linked to pulmonary issues that may occur after TSA. The analysis revealed that the pneumonia rates decreased each year, whereas the PE rates remained relatively stable. A noticeable and consistent increase was found in respiratory failure from 2010 to 2019. The findings suggests that individuals who are older (primarily between the ages of 60 and 80 years) and female exhibit increased rates. These factors could help stratify patients and reduce the risk of potential complications. This claim is especially applicable in PE because it is associated with more significant improvements in resource utilization.

Robotic hysterectomy has emerged as a superior surgical approach for patients with obesity, providing significant benefits including reduced incidence of myocardial infarction, peripheral nerve injury, wound infections, and urinary tract infections. However, these unique considerations require careful attention when managing such cases. Therefore, this study aimed to propose several key strategies for achieving optimal outcomes, including maintaining a mild Trendelenburg position (12°), ensuring the patient's secure positioning, avoiding the lithotomy position, considering a slightly higher pneumoperitoneum insufflation pressure (12 mmHg), and using a 30° endoscope for improved visualization rather than a 0° endoscope. We present three cases of stage IA atypical endometrial hyperplasia and carcinoma. All three patients underwent robotic hysterectomy and bilateral salpingo-oophorectomy, with body mass indices of 53.3, 43.8, and 43.7 kg/m2.

To compare the success and complication rates of radial artery catheterization using ultrasound guidance versus the conventional palpation technique in obese patients by anesthesia residents with similar levels of experience in both methods, and to measure the skin-to-artery distance of radial, brachial, and dorsalis pedis arteries using ultrasound with standardized anatomic landmarks.

Prospective, randomized controlled trial SETTING: Single tertiary center PARTICIPANTS: Eighty adults with a body mass index (BMI) ≥30 kg/m2 INTERVENTIONS: Ultrasound guidance or conventional palpation method MEASUREMENTS AND MAIN RESULTS: The primary outcome was the first-attempt success rate of arterial catheterization. The skin-to-artery distance of the radial artery was significantly greater in the BMI groups of 40 to 49 kg/m2 and ≥50 kg/m2 compared to the BMI group of 30 to 39 kg/m2 (mean difference, 1.0 mm; 95% confidence interval [CI], 0.4-1.7; p = 0.0029) for BMI 40-49 kg/m2 vs 30-39 kg/m2 and 1.5 mm (95% CI, 0.6-2.4 mm; p = 0.0015) for ≥50 kg/m2 vs 30-39 kg/m2. Similar findings were observed for the brachial artery. BMI was inversely associated with first-attempt success rates (p = 0.0145) and positively with time to successful catheterization (p = 0.0271). The first-attempt success and vascular complication rates of catheterization did not differ significantly between the ultrasound guidance group (65.0% and 52.5%, respectively) and the conventional palpation group (70.0% [p = 0.6331] and 57.5% [p = 0.6531], respectively).

The results of this study do not support the routine use of ultrasonography during radial arterial catheterizations for obese adults when junior practitioners perform the procedure.

To identify and describe assessment tools used to measure the impact of comorbidities on postoperative outcomes in children with complex chronic conditions (CCC).

This was a scoping review using five electronic databases. The search was conducted in March 2022 by a medical librarian. There were no date or language restrictions. Included studies were full-text articles published in peer-reviewed journals that described a tool used to measure the impact of comorbidities in children with CCC to assess postoperative outcomes. A standardized data charting tool was used.

A total of 2157 articles were retrieved. Five studies reporting on six comorbidity measures met inclusion criteria. All were cohort studies and were secondary analyses of data from an administrative database (n = 4) or a patient registry (n = 1). Sample sizes ranged from 645 to 25 747 participants. One paper described the assessment of reliability. Only one form of validity - predictive validity - was assessed in three papers for five measures.

Findings from this scoping review revealed a paucity of comorbidity assessment tools validated for use with children with CCC; significant conceptual and measurement challenges exist in the current scientific literature.

Five studies used formal risk assessment approaches to evaluate postoperative outcomes in children with complex chronic conditions. Conceptual and methodological differences between comorbidity indexes and risk prediction models are explicated. Further development of prediction science is needed for determining postoperative outcomes. Enhanced preoperative comorbidity assessment will identify children at risk of poor outcomes.

Background: As the population ages, the prevalence of surgical interventions in individuals aged 65+ continues to increase. This poses unique challenges due to the higher incidence of comorbidities, polypharmacy, and frailty in the elderly population, which result in high peri-operative risks. Traditional preoperative risk assessment tools often fail to accurately predict post-operative outcomes in the elderly, overlooking the complex interplay of factors that contribute to risk in the elderly. Methods: A literature review was conducted, focusing on the predictive value of CGA for postoperative prognosis and the implementation of perioperative interventions. Results: Evidence shows that CGA is a superior predictive tool compared to traditional models, as it more accurately identifies elderly patients at higher risk of complications such as postoperative delirium, infections, and prolonged hospital stays. CGA includes assessments of frailty, sarcopenia, nutritional status, cognitive function, mental health, and functional status, which are crucial in predicting post-operative outcomes. Studies demonstrate that CGA can also guide personalized perioperative care, including nutritional support, physical training, and mental health interventions, leading to improved surgical outcomes and reduced functional decline. Conclusions: The CGA provides a more holistic approach to perioperative risk assessment in elderly patients, addressing the limitations of traditional tools. CGA can help guide surgical decisions (e.g., curative or palliative) and select the profiles of patients that will benefit from perioperative interventions to improve their prognosis and prevent functional decline.

Elevated body mass index (BMI) is a known perioperative risk factor for complications such as delayed wound healing and infection. However, there is a gap in understanding how elevated BMI impacts outcomes after posttraumatic lower extremity (LE) microvascular reconstruction.

A retrospective review was performed at a level 1 trauma center between 2007 and 2022 of patients who underwent posttraumatic microvascular LE reconstruction. Demographics, flap/wound details, complications, and outcomes were recorded. Patients were stratified into BMI Center for Disease Control categories.

A total of 398 patients were included with an average BMI of 28.2 ± 5.8. Nearly half (45%) of LE defects were located in the distal third of the leg, 27.5% in the middle third, and 34.4% in the proximal third. Most reconstructions utilized muscle-containing flaps (74.4%) compared with fasciocutaneous flaps (16.8%). Surgical approaches included free flaps (47.6%) and local flaps (52.5%). Class III obese patients were significantly more likely to be nonambulatory than nonobese patients (OR: 4.10, 95% CI 1.10-15.2, p = 0.035). At final follow-up, 30.1% of patients with Class III obesity were ambulatory, requiring either wheelchairs (42.3%) or assistance devices (26.9%). There were no significant differences in complication rates based on obesity status (0.704). The average follow-up time for the entire cohort was 5.8 years.

BMI is critical for patient care and surgical decision-making in LE reconstruction. Further research is warranted to optimize outcomes for higher BMI patients, thereby potentially reducing the burden of postoperative complications and enhancing overall patient recovery.

Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP.

In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed.

Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion.

Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage.

Increased body mass index (BMI) is a potential risk factor for poorer outcomes and complications. However, the influence of BMI on the long-term outcomes of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) remains to be fully elucidated.

Institutional records were queried to identify patients who underwent primary total shoulder arthroplasty (TSA) between 2009 and 2020 with a minimum of 2 years of clinical follow-up. Retrospective review was performed to collect demographic characteristics; comorbidity status; and range-of-motion and strength measurements in forward elevation, external rotation, and internal rotation. Patients were contacted by telephone to provide patient-reported outcomes (PROs). Patients were stratified into 3 cohorts by BMI: underweight or normal weight (U/NW, BMI ≤25 kg/m2), overweight (OW, BMI >25 to ≤30 kg/m2), and obese (BMI >30 kg/m2).

Among 466 TSA patients, 245 underwent aTSA whereas 221 underwent rTSA. In the aTSA cohort, 40 patients were classified as U/NW; 72, as OW; and 133, as obese. Comparatively, the rTSA cohort was composed of 33 U/NW, 79 OW, and 209 obese patients. Patients in the aTSA and rTSA cohorts had an average follow-up period of 5.8 ± 3.2 years and 4.5 ± 2.3 years, respectively. No differences in age at surgery were found in the aTSA group (U/NW vs. obese, 65.2 ± 7.9 years vs. 61.9 ± 8.9 years; P = .133); however, in the rTSA cohort, BMI was found to be inversely related to age at surgery (U/NW vs. obese, 72.4 ± 8.8 years vs. 65.7 ± 8.3 years; P < .001). Across all BMI cohorts, patients saw great improvements in range of motion and strength. Postoperative PROs after TSA did not vary by BMI in terms of Single Assessment Numeric Evaluation, Simple Shoulder Test, visual analog scale pain, and American Shoulder and Elbow Surgeons scores. There was no significant difference in survival rates at 10-year follow-up in the aTSA cohort (U/NW vs. obese, 95.8% vs. 93.2%; P = .753) or rTSA cohort (U/NW vs. obese, 94.7% vs. 94.5%; P = .791).

With dramatic improvements in range of motion, minimal differences in PROs, and high rates of implant survival, TSA is a safe and effective treatment option for all patients, including overweight and obese patients.

Obesity is increasing worldwide, and data are limited on how body mass index (BMI) affects surgical risk in pelvic organ prolapse. This study is aimed at evaluating the impact of obesity on outcomes after apical pelvic organ prolapse surgery. We hypothesize that obese patients have higher rates of postoperative complications.

This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2018. Current Procedural Terminology codes identified subjects aged 18-89 who underwent apical prolapse repair, including vaginal colpopexy and laparoscopic or robotic sacrocolpopexy. Minor and major complications were analyzed using the World Health Organization BMI category. Regression analysis was performed to adjust for confounders.

The total cohort was 24,718 with 15,137 vaginal colpopexy and 9,581 laparoscopic/robotic sacrocolpopexy. The average age was 60.1, 76.5% were white, 24.2% were American Society of Anesthesiologists (ASA) class 3 or 4, and 44.7% had a major medical comorbidity. Eight hundred and eighty-five patients (5.4%) experienced a minor complication, 324 (2.0%) a major complication, and 1,167 (7.2%) any complication. There was no difference in any, major, or minor complication by BMI and this persisted after adjusting for age, race, ASA class, smoking, and surgical approach.

There is no difference in complication rates after apical prolapse surgery by BMI regardless of age, race, ASA class, smoking use, and surgical approach. Patients and surgeons should be reassured that minimally invasive apical prolapse surgery is safe, with low complication rates. Randomized controlled trials are needed to verify these findings.

Over the past 20 years, there has been an increase in demand for complete knee replacements, and this trend is predicted to continue. It has been shown that being overweight is a risk factor for knee osteoarthritis. There are only a few studies on this in India and none on South Indian patients, Therefore, our goal was to evaluate how BMI affected functional outcomes after primary total knee replacement.

To determine the impact of body mass index (BMI) on functional outcomes after primary total knee replacement.

ology: Patients who underwent total knee replacement between November 2021 and November 2023 were included in the study. Patients were divided into groups based on BMI. Group I patients have a BMI less than 25, and group II patients of BMI greater than 25. International Knee Society scoring(IKSS) is used to assess patients Preoperatively and postoperatively.

Out of 185 patients, 70 were males and 115 were females. When IKSS scores were analyzed the mean Knee score before surgery in Group 1 was 24.58 and in Group 2 it was 16.64. After 1 year follow up the mean scores were 68.5 and 57.5 respectively. When analyzed with functional score the pre-op scores for groups 1 and 2 were 32.58 and 23.44 respectively and post-op scores after one-year follow-up were 71.17 and 51.7 respectively.

BMI does have a positive correlation with both preoperative and postoperative scores. A weight-loss programme can be discussed with the patients presenting the results of this study.

Ensuring patient safety during small animal anaesthesia is crucial. This study aimed to assess anaesthetic-related deaths in dogs globally, identify risks and protective factors and inform clinical practice.

This prospective cohort multicentric study involved 55,022 dogs from 405 veterinary centres across various countries. Data on anaesthesia-related deaths from premedication to 48 hours post-extubation were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs used.

Anaesthetic-related mortality was 0.69%. Most deaths occurred postoperatively (81%). Age, obesity and a higher ASA classification score were associated with increased mortality. Urgent procedures, non-urgent but unscheduled anaesthesias and short procedures also had higher mortality. Some sedatives, systemic analgesics, hypnotics and the use of locoregional anaesthesia were linked to a decrease in mortality.

The limitations of the study include the non-randomised sample, potential selection bias, lack of response rate quantification, variable data quality control, subjectivity in classifying causes of death and limited analysis of variables.

Careful patient evaluation, drug selection and monitoring can be associated with reduced mortality. These findings can be used to develop guidelines and strategies to improve patient safety and outcomes. Further research is needed to refine protocols, enhance data quality systems and explore additional risk mitigation measures.

The existing data on the link between body mass index (BMI), operative characteristics, and surgical outcomes across orthognathic surgery are limited.

The purpose was to measure the association between BMI and early postoperative outcomes in orthognathic surgery.

This is a retrospective cohort study of patients (n = 118) aged > 14 years undergoing bimaxillary orthognathic surgery between 2015 and 2018 by a single surgeon within the Kaiser Permanente Northern California-integrated healthcare system. Patients undergoing unilateral or additional procedures, history of prior orthognathic surgery, or pre-existing pain conditions were excluded.

The predictor variable was BMI measured as a continuous (kg/m2) and categorical variable (underweight/normal, overweight, obese).

The primary outcome variables were additional postoperative antibiotics, increased postoperative visits, wound dehiscence, and wound infection. The secondary outcome variables were total operative and anesthesia time.

The demographic covariates included age, sex, and race/ethnicity. The clinical covariates included history of obstructive sleep apnea, Mallampati score, tobacco use, American Society of Anesthesia classification, thyromental distance, history of difficult intubation, and Angle's classification.

Bivariate and multivariate analyses were performed to measure the associations between BMI and the primary and secondary outcomes. Multivariable logistic regression analyses were used to measure associations between BMI and the postoperative outcomes. Statistical significance was defined as P < .05.

The study sample was composed of 118 subjects with a mean age of 26.91 years (standard deviation 9.43). Forty-seven percent (n = 55) were male, and the mean BMI was 25.13 (standard deviation 5.19). BMI category was significantly associated with age, with increasing age associated with higher BMI category (P = .02). According to the bivariate and multivariable logistic regression analyses, controlling for age, race/ethnicity, BMI, and total operative time, increased total operative time was associated with additional postoperative antibiotics (odds ratio = 1.03, 95% confidence interval: 1.01, 1.05), and increased postoperative appointments (odds ratio = 1.02, 95% confidence interval: 1.01, 1.04). No significant association between BMI and other clinical or operative characteristics was seen aside from American Society of Anesthesia classification.

Elevated BMI was not associated with worsened operative characteristics or postoperative outcomes. This supports the suitability of orthognathic surgery in a BMI-diverse population.

Patients with obesity presenting in need of surgical intervention are at 2-to-sixfold higher risk of prolonged hospitalization, infectious morbidity, venous thromboembolism, and more. To mitigate some of these concerns, prescribed preoperative weight loss via very low-energy diets (VLEDs) has become a standard of care for patients with obesity undergoing bariatric surgery. While VLEDs have become standard prior to bariatric surgery, their application in other surgical settings remains limited. A large, definitive trial is required to resolve the uncertainty surrounding their use in these patients. Prior to a definitive trial to compare the efficacy of VLEDs in patients with obesity undergoing major non-bariatric surgery, we require a pilot trial. We argue a pilot trial will provide the following critical feasibility insights: (1) assessment of recruitment ability, (2) evaluation of adherence to VLED regimens, and (3) assessment of our ability follow patients completely.

The proposed trial will be a multi-center, surgeon, outcome assessor, and data-analyst blinded, parallel pilot randomized controlled trial (RCT). Patients older than 18 years of age with a body mass index (BMI) of greater than 30 kg/m2 undergoing major elective non-bariatric surgery will be eligible for inclusion. Consecutive patients will be allocated 1:1 according to a computer-generated randomization schedule. Randomization will be stratified by center and will employ randomly permutated blocks. All patients in the intervention group will receive standard patient counseling on weight loss and an active VLED protocol. The preoperative VLED protocol will utilize commercially available weight loss products for three weeks preoperatively. The primary outcomes (randomization percentage, recruitment rate, intervention adherence, follow-up completion, network development) will assess feasibility. Descriptive statistics will be used to characterize the study sample.

The PREPARE pilot RCT will aim to provide feasibility and safety data that will allow for the successful completion of the definitive PREPARE trial that has the potential to provide practice changing data pertaining to the regular use of VLEDs as a means of pre-habilitation for patients with obesity undergoing major non-bariatric surgery.

This study was registered on ClinicalTrials.gov (reference #NCT05918471) on June 23, 2023.

The post-anesthesia care unit (PACU) plays a crucial role in providing specialized care to postoperative patients. However, a subset of these patients experiences complications that result in a prolonged stay of 90 minutes or more in the PACU. This not only impacts the patient's quality of life but also disrupts hospital workflow, as it might cause postoperative pain, nausea, or vomiting. It is essential to identify the factors contributing to this prolonged length of stay (LOS) and explore strategies for its prevention and management.  Methods: We conducted a retrospective cohort study of postoperative patients between 2020 and 2021. We included patients who had a prolonged stay, excluding cardiac patients, patients who had a planned prolonged stay, and patients waiting for an intensive care unit bed. We used a non-probability consecutive sampling technique. Data were obtained from the BestCare System, the hospital's information system, using a data collection sheet.

A total of 15,170 patients underwent surgical procedures during the study period, out of which only 181 (1.19%) experienced a prolonged PACU stay. Pain and altered mental status were strongly associated with a prolonged PACU stay (P = 0.035 and P = 0.0009, respectively). However, there was no significant association between overall comorbidities and prolonged LOS in the PACU, except for patients with asthma (P = 0.003). Different types and durations of surgeries did not significantly contribute to a prolonged PACU stay.

Our study found that among the various variables examined, asthma, pain, and altered mental status were significantly associated with a prolonged LOS in the PACU. These findings suggest that targeted interventions addressing these factors may help reduce the incidence of prolonged PACU stays and optimize patient outcomes.

Obesity is steadily increasing in the United States and is a risk factor for many medical and surgical complications. Literature is limited regarding obesity as an independent risk factor for perioperative complications after reconstructive pelvic surgery (RPS).

This study aimed to analyze the association of obesity on 30-day perioperative complications after RPS.

This was a database study comparing perioperative complications after RPS of obese versus nonobese patients using the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected, and perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index ≥30 (calculated as weight in kilograms divided by height in meters squared).

A total of 13,302 patients met the inclusion criteria and were included in this study; 4,815 patients were obese, whereas 8,487 were nonobese. The overall rate of any 30-day postoperative complication was 6.8%, and the rate of complications did not differ between groups. Superficial and organ space surgical site infections were significantly higher in the obese cohort, whereas nonobese patients were more likely to receive a blood transfusion. A multivariable logistic regression model was performed with variables that were statistically significant on bivariate analysis and deemed clinically significant. Variables included obesity, age, American Society of Anesthesiologists class, current smoker, diabetes, hypertension, operative time, colpopexy, and obliterative procedure. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative complications after pelvic organ prolapse surgery.

Obesity was not associated with 30-day postoperative complications after RPS after controlling for possible confounding variables.

Obesity is a well-known public health concern in Western World. Accordingly, an elevated number of obese patients undergo thyroidectomy every year. We aim to assess the impact of obesity on intraoperative and postoperative outcomes of patients who undergo thyroidectomy. 1228 patients underwent thyroidectomy at our department between January 2021 and September 2021. We divided patients into two groups according to body mass index (BMI): non-obese (BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). A propensity score approach was performed to create 1:1 matched pairs (matching according to age, gender, diagnosis, nodule size and type of operation). After matching, the final population included 522 patients, equally divided between each group: non-obese group (Group A; n = 261) and obese group (Group B; n = 261). The primary endpoint of the study was the overall rate of postoperative complications; secondary endpoints of the study were operative time, use of energy device and length of hospital stay. The duration of hospital stay resulted longer in Group B (p = 0.002). No statistically significant differences were documented in terms of operative time (p = 0.206), use of energy devices (p = 0.855) and surgical complications (p = 0.429). Moreover, no statistically significant differences were documented considering each specific complication: transient and permanent hypocalcemia (p = 0.336; p = 0.813, respectively), transient and permanent recurrent laryngeal nerve palsy (p = 0.483; p = 0.523, respectively), hematoma (p = 0.779), bleeding (p = 0.178), wound infection (p = 0.313) and cheloid formation (p = 0.412). Thyroidectomy can safely be performed in obese patients. Outcomes resulted comparable; nonetheless, obesity correlates to longer hospital stay.

Respiratory mechanics are often significantly altered in morbidly obese patients and magnesium sulfate (MgSO4) is a promising agent for managing several respiratory disorders. This study aimed to examine the effects of MgSO4 infusions on arterial oxygenation and lung mechanics in patients with morbid obesity undergoing laparoscopic bariatric surgery.

Forty patients with morbid obesity aged 21-60 years scheduled for laparoscopic bariatric surgery under general anesthesia were randomly allocated to either the control (normal saline infusion) or MgSO4 group (30 mg/kg lean body weight [LBW] of 10% MgSO4 in 100 ml normal saline intravenously over 30 min as a loading dose, followed by 10 mg/kg LBW/h for 90 min). The primary outcome was intraoperative arterial oxygenation (ΔPaO2/FiO2). Secondary outcomes included intraoperative static and dynamic compliance, dead space, and hemodynamic parameters.

At 90 min intraoperatively, the Δ PaO2/FiO2 ratio and the Δ dynamic lung compliance were statistically significantly higher in the MgSO4 group (mean ± SE: 16.1 ± 1.0, 95% CI [14.1, 18.1] and 8.4 ± 0.5 ml/cmH2O, 95% CI [7.4, 9.4]), respectively), and the Δ dead space (%) was statistically significantly lower in the MgSO4 group (mean ± SE: -8.0 ± 0.3%, 95% CI [-8.6, -7.4]) (P < 0.001). No significant differences in static compliance were observed.

Although MgSO4 significantly preserved arterial oxygenation and maintained dynamic lung compliance and dead space in patients with morbid obesity, the clinical relevance is minimal. This study failed to adequately reflect the clinical importance of these results.

To perform a systematic review and meta-analysis to evaluate the impact of body mass index (BMI) on oncological (primary) and surgical (secondary) outcomes of patients who underwent nephrectomy, as obesity or high BMI is a known risk factor for renal cell carcinoma (RCC) and predictor of poorer outcomes.

Studies were identified from four electronic databases from database inception to 2 June 2021, according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. The review protocol was registered in the International Prospective Register of Systematic Reviews with the identification number: CRD42021275124.

A total of 18 studies containing 13 865 patients were identified for the final meta-analysis. Regarding oncological outcomes, higher BMI predicted higher overall survival (BMI >25 vs BMI <25 kg/m2 : hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58-0.85), cancer-specific survival (BMI >25 vs BMI <25 kg/m2 : HR 0.60, 95% CI 0.50-0.73; BMI 25-30 vs BMI <25 kg/m2 : HR 0.46, 95% CI 0.23-0.95; BMI >30 vs BMI <25 kg/m2 : HR 0.50, 95% CI 0.36-0.69), and recurrence-free survival rates (BMI >25 vs BMI <25 kg/m2 : HR 0.72, 95% CI 0.63-0.82; BMI 25-30 vs BMI <25 kg/m2 : HR 0.59, 95% CI 0.42-0.82). Those with a lower BMI fared better in surgical outcomes, such as operation time and warm ischaemic time, although the absolute difference was minimal and unlikely to be clinically significant. There was no difference between groups for length of hospital stay, intraoperative or postoperative complications, blood transfusion requirements, and conversion to open surgery.

Our study suggests that a higher BMI is associated with improved long-term oncological survival and similar perioperative outcomes as a lower BMI. More research into the underlying biological and physiological mechanisms will enable better understanding of the effect of BMI, beyond mere association, on post-nephrectomy outcomes.

Increasing adoption of implant-based breast reconstruction (IBR) has raised expectations regarding postoperative outcomes and aesthetic results. BMI has been extensively explored as a predictor of complications. This study is the first to examine complication rates in underweight subjects, and compares these rates among underweight, normal weight, overweight, and obese patients.

The aim of this study was to investigate the influence of BMI on postoperative complications and aesthetic results in IBR following mastectomy.

Retrospective analysis encompassed patients undergoing mastectomy with subsequent IBR, performed by a collaborative team of breast and plastic surgeons. Demographics, treatment specifics, and outcomes were evaluated by univariate and multivariate regression models. Significance was determined at P < .05.

In total, 1046 IBRs were performed in 921 patients, of whom 63 had a BMI <18.5 kg/m2, 572 were normal weight, 215 were overweight, and 71 were obese. Significantly higher complication rates were observed in both obese and overweight patients compared with normal-weight patients (P < .001). Each unit increase in BMI correlated to 7% increased odds of overall complications and 13% increased odds of reconstructive failure. Underweight individuals had higher capsular contracture rates than normal-weight patients, 14.3% vs 3.65%, respectively (P = .001). In addition, aesthetic complications rates in underweight patients were higher than in normal-weight patients, 36.4% vs 25.7%, respectively (P < .05).

This study confirmed BMI to be a strong predictor of postoperative complications and aesthetic outcomes, and demonstrates that low BMI has a significant impact on the incidence of capsular contracture and aesthetic complications.

Carpometacarpal (CMC) arthroplasty is an effective surgical treatment to relieve pain and improve function for osteoarthritis of the CMC joint. The association between body mass index (BMI) and postoperative complications has been studied for other orthopedic procedures, including total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty. However, BMI has not been studied as a risk factor for postoperative complications following CMC arthroplasty. The purpose of this study was to determine the postoperative complications associated with different categories of BMI following CMC arthroplasty. We hypothesized that increasing BMI is associated with more severe complications.

The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent CMC arthroplasty between 2015 and 2020. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. Patients were stratified into cohorts based on BMI as follows: underweight (BMI < 18.5 kg/m2), normal/reference (18.5 kg/m2 ≤ BMI < 30.0 kg/m2), obese (30.0 kg/m2 ≤ BMI < 35.0 kg/m2), severely obese (35.0 kg/m2 ≤ BMI < 40.0 kg/m2), and morbidly obese (BMI ≥ 40.0 kg/m2). Multivariate logistic regression was used to identify postoperative complications associated with each cohort.

In total, 6,432 patients were included in this study: 3,622 (56.3%) patients were included in the normal/reference cohort, 77 (1.2%) patients were included in the underweight cohort, 1,479 (23.0%) patients were included in the obese cohort, 718 (11.2%) patients were included in the severely obese cohort, and 536 (8.3%) patients were included in the morbidly obese cohort. The obese cohort was independently associated with a higher rate of superficial incisional surgical-site infection (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.00-4.44; P = .050). The morbidly obese cohort was independently associated with readmission (OR, 3.35; 95% CI, 1.15-9.74; P = .026) and reoperation (OR, 3.40; 95% CI, 1.04-1.11; P = .043).

Morbid obesity is a clinically significant predictor for readmission and reoperation within 30 days following CMC arthroplasty. Obesity is a clinically significant predictor for superficial incisional surgical-site infection within 30 days following CMC arthroplasty.

A better understanding of BMI as a risk factor for postoperative complications may allow surgeons to improve preoperative risk stratification and patient counseling.

Prognostic III.

There is a lack of evidence on whether perioperative outcomes differ in obese patients after video-assisted thoracic surgery (VATS) or open lobectomy. We queried the European Society of Thoracic Surgeons database to assess morbidity and postoperative length of hospital stay in obese patients submitted to VATS and open pulmonary lobectomy for non-small-cell lung cancer.

We collected all consecutive patients from 2007 to 2021 submitted to lobectomy through VATS or thoracotomy with a body mass index greater than or equal to 30. An intention-to-treat analysis was carried out. Primary outcomes were morbidity rate, mortality and postoperative length of stay (LOS). Differences in outcomes were assessed through univariable, multivariable-adjusted and propensity score-matched analysis.

Out of a total of 78 018 patients submitted to lung lobectomy, 13 999 cases (17.9%) were considered in the analysis, including 5562 VATS lobectomies and 8437 thoracotomy lobectomies. The VATS group showed a lower complication rate (23.2% vs 30.2%, P < 0.001), mortality (0.8% vs 1.5%, P < 0.001) and postoperative LOS (median 5 vs 7 days, P < 0.001). After propensity score matching, the VATS approach confirmed a lower complication rate (24.7% vs 29.7%, P = 0.002) and postoperative LOS (median 5 vs 7 days, P < 0.001). Moreover, these results were consistently observed when analyzing the severe obese subgroup (body mass index 35-39.9) and morbid obese subgroup (body mass index ≥40).

In obese patients with non-small cell lung cancer, VATS lobectomy was found to be associated with improved postoperative outcomes than open lobectomy. Consequently, it should be considered the approach of choice for the Obese population.

Although robotic distal pancreatectomy (RDP) has a lower conversion rate to open surgery and causes less blood loss than laparoscopic distal pancreatectomy (LDP), clear evidence on the impact of the surgical approach on morbidity is lacking. Prior studies have shown a higher rate of complications among obese patients undergoing pancreatectomy. The primary aim of this study is to compare short-term outcomes of RDP vs. LDP in patients with a BMI ≥ 30.

In this multicenter study, all obese patients who underwent RDP or LDP for any indication between 2012 and 2022 at 18 international expert centers were included. The baseline characteristics underwent inverse probability treatment weighting to minimize allocation bias.

Of 446 patients, 219 (50.2%) patients underwent RDP. The median age was 60 years, the median BMI was 33 (31-36), and the preoperative diagnosis was ductal adenocarcinoma in 21% of cases. The conversion rate was 19.9%, the overall complication rate was 57.8%, and the 90-day mortality rate was 0.7% (3 patients). RDP was associated with a lower complication rate (OR 0.68, 95% CI 0.52-0.89; p = 0.005), less blood loss (150 vs. 200 ml; p < 0.001), fewer blood transfusion requirements (OR 0.28, 95% CI 0.15-0.50; p < 0.001) and a lower Comprehensive Complications Index (8.7 vs. 8.9, p < 0.001) than LPD. RPD had a lower conversion rate (OR 0.27, 95% CI 0.19-0.39; p < 0.001) and achieved better spleen preservation rate (OR 1.96, 95% CI 1.13-3.39; p = 0.016) than LPD.

In obese patients, RDP is associated with a lower conversion rate, fewer complications and better short-term outcomes than LPD.

Body mass index (BMI) and waist circumference (WC) were used to evaluate nutritional status and obesity. We aimed to examine whether preoperative BMI or WC was associated with mortality after cancer surgery.

This population-based cohort study used data extracted from the National Health Insurance Service database of South Korea. We included adult patients who underwent major cancer surgery with curative intent between January 1, 2016, and December 31, 2020.

A total of 87,220 patients were included in the final analysis, and 1,374 (1.6%) died within 90 days after cancer surgery. In the multiple logistic regression model, the BMI < 18.5/kg/m² and > 35 kg/m² groups showed 1.98-fold (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.58-2.49; P < 0.001) and 2.60-fold (OR, 2.60; 95% CI, 1.25-5.40; P < 0.001) higher 90-day mortality after cancer surgery than did the BMI 18.5-24.9 kg/m² group. The 25.0-29.9 kg/m² (P = 0.144) and 30.0-34.9 kg/m² (P = 0.105) BMI groups did not show significant differences compared to the BMI 18.5-24.9 kg/m² group. Compared with the normal WC group, the high (P = 0.052) and very high (P = 0.232) WC groups also did not show significant differences in terms of 90-day mortality.

Preoperative BMI < 18.5 kg/m² and > 35 kg/m² is associated with an elevated risk of 90-day mortality after major cancer surgery. However, preoperative WC was not significantly associated with 90-day mortality after cancer surgery.

The increase in incidence of thyroid cancer correlates with strict increases in body mass index (BMI) and obesity in the United States. Thyroid hormone dysregulation has been shown to precipitate circulatory volume, peripheral resistance, cardiac rhythm, and even cardiac muscle health. Theoretically, thyroid surgery could precipitate injury to the cardiopulmonary system.

The American College of Surgery National Quality Improvement Program database was queried for thyroidectomy cases in the 2007-2020 Participant User files. Continuous and categorical associations between BMI and cardiopulmonary complications were investigated as reported in the database.

The query resulted 186,095 cases of thyroidectomy procedures in which the mean age was 51.3 years and sample was 79.3% female. No correlation was evident in univariate and multivariate analyses between BMI and the incidence of postoperative stroke or myocardial infarction. The incidence of complications was extremely low. However, risk of deep venous thrombosis correlated with BMI in the categorical, univariate, and multivariate (OR 1.036, CI 1.014-1.057, p < 0.01) regression analysis. Additionally, increased BMI was associated with increased risk of pulmonary embolism (PE) (OR 1.050 (1.030, 1.069), p < 0.01), re-intubation (OR 1.012 (1.002, 1.023), p = 0.02), and prolonged intubation (OR 1.031 (1.017, 1.045), p < 0.01).

Despite the rarity of cardiopulmonary complications during thyroid surgery, patients with very high BMI carry a significant risk of deep venous thrombosis, PE, and prolonged intubation.

3 Laryngoscope, 133:2823-2830, 2023.

Increased body mass index is a known risk factor for increased adverse events post-hysterectomy. The effects of previous bariatric surgery on outcomes after inpatient hysterectomy are not well elucidated.

The 2016 to 2018 National Inpatient Sample was queried for patients who underwent hysterectomy using International Classification of Disease 10 Procedure Codes before a matched analysis was performed to neutralize the potential confounding effects of comorbidities, body mass index, and age. Patients were divided into the following 2 groups: a case group (those with a history of bariatric surgery) and a control group (those without a history of bariatric surgery). Patients in the respective groups were matched 1:2 by age, Elixhauser comorbidity score, and body mass index at the time of surgery to analyze the risk of complications and mean length of stay.

When 1:2 case-control matching was performed, women with a history of bariatric surgery (N = 595) had significantly fewer complications and decreased mean length of stay than the non-bariatric group (N = 1,190), even after controlling for body mass index at the time of hysterectomy.

When matched for age, body mass index, and comorbidity score, patients with previous bariatric surgery had fewer complications and shorter lengths of stay than patients without a history of bariatric surgery. Women with a body mass index ≥40 kg/m2 requiring non-urgent hysterectomy may benefit from undergoing bariatric surgery first.

Obesity and urolithiasis are both prevalent conditions that have an impact on the healthcare system. The ureteric diameter and accessibility play a crucial role in the management of urolithiasis in both overweight and normal weight patients. Studies have shown that obesity can lead to changes in ureter diameter where excessive body fat can exert pressure on the kidneys, causing them to enlarge in size and this enlargement can result in a compression of the adjacent structures, including the ureter. The aim of this study is to assess the incidence of intraoperative challenges faced during retrograde ureteroscopic procedures in overweight patients with ureteric and renal calculi.

We retrospectively reviewed patients who underwent retrograde ureteroscopic surgery (RURS) for urolithiasis from 1st January 2021 until 30th August 2023. The outcome and any complications were documented and compared with the patient's Body Mass Index (BMI). All patients who undergo RURS in our facility have to have a Non-Contrast CT scan prior to surgery. Procedural success was determined by the ability to obtain access to the stone site intraoperatively and stone-free status in kidney, ureter, and bladder (KUB) X-ray post-operatively. Post-operative complications were recorded up to two weeks post-operatively and classified according to the Calvein Dindo Classification.

Our total sample size was 146 patients out of which 75 were overweight and 71 were normal weight patients. In 34 (45%) of overweight patients' access to the ureter was restricted due to a narrow ureteric orifice with ureteroscopy not successful; on the contrary 13 (18%) of normal weight patients faced this same issue. This was statistically significant with a p-value of .004. The stone clearance rates were 91% and 95% in overweight and normal weight patients respectively, which is higher in normal weight patients however this difference was not found to be a statistically significant finding (p-value .028). Overweight patients had 12% Grade I and 8% Grade II complications whereas normal weight patients had 11% Grade I complications and 1.4% Grade II with no higher-grade complications.

Retrograde ureteroscopic procedures are a safe treatment modality for patients with urolithiasis in both overweight and normal weight populations. They are shown to have similar success rates between both populations once ureteric access is obtained. However, access failure rates are shown to be slightly higher in overweight patients. Hence, further preoperative patient counselling and technical considerations should be undertaken.

A longitudinal, descriptive, prospective, and prolective study of individuals with endometrial or cervical cancer/pre-cancer diagnoses and high BMI (over 35 kg/m2) undergoing RH was conducted. Of the 53 participants recruited, 3 (6%) were converted to open surgery. The 50 RH participants had median BMI 42 kg/m2 (range 35 to 60): the range 35-39.9 kg/m2 had 17 cases; the range 40-44.9 kg/m2 had 15 cases; 45-49.9 kg/m2 8 cases; and those ≥50 kg/m2 comprised 10 cases. The mean RH operating time was 128.1 min (SD 25.3) and the median length of hospital stay was 2 days (range 1-14 days). Increased BMI was associated with small, but statistically significant, increases in operating time and anaesthetic time, 65 additional seconds and 37 seconds, respectively, for each unit increase in BMI. The median self-reported time for individuals who underwent RH to return to their pre-operative activity levels was 4 weeks (range 2 to >12 weeks). There was a significant improvement in pain and physical independence scores over time (p = 0.001 and p < 0.001, respectively) and no significant difference in scores for overall QOL, pain, or physical independence scores was found between the BMI groups. Patient-reported recovery and quality of life following RH is high in individuals with high BMI (over 35 kg/m2) and does not appear to be impacted by the severity of obesity.

Acoustic neuromas are the most common tumor of the cerebellopontine angle that are associated with a number of symptoms that negatively impact a patient's quality of life. While the mainstay of treatment for these benign tumors remains microsurgical resection, there is limited research exploring how certain modifiable risk factors (MRFs) may affect the perioperative course. The purpose of this study was to investigate how MRFs including malnutrition, obesity, dyslipidemia, uncontrolled hypertension, and smoking may affect postoperative rates of readmission and nonroutine discharges. We utilized the 2016 and 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database. MRFs were queried using appropriate International Classification of Diseases, Tenth Revision (ICD-10) coding for categories including malnutrition, obesity, dyslipidemia, smoking, alcohol, and hypertension. The statistical analysis was done using RStudio (Version 1.3.959). Chi-squared tests were done to evaluate differences between categorical variables. The Mann-Whitney U-testing was utilized to evaluate for statistically significant differences in continuous data. The "Epitools" package was used to develop logistic regression models for postoperative complications and post hoc receiver operating characteristic curves were developed. Pertaining to nonroutine discharge, predictive models using malnutrition outperformed all other MRFs as well as those with no MRFs (P < .05). In the case of readmission, models using malnutrition outperformed those of obesity and smoking (P < .05). Again, an increase in predictive power is seen in models using dyslipidemia when compared to obesity, smoking, or uncontrolled hypertension. Lastly, models using no MRFs outperformed those of obesity, smoking, and uncontrolled hypertension (P < .05). This is the first study of its kind to evaluate the role of MRFs in those undergoing surgical resection of their acoustic neuroma. We concluded that certain MRFs may play a role in complicating a patient's perioperative surgical course.

Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.