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Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients.

ABSTRACT: Protein deficiency (PD) is a known risk factor for surgical complications; however, the risks of PD by weight class have not been well described. It was hypothesized that the combination of obesity and PD is associated with increased surgical complications compared with normal weight and normoalbuminemic patients.A total of 85,833 general surgery patients undergoing elective operations within the 2011 National Surgical Quality Improvement Program were analyzed. Patients with conditions that could potentially confound serum albumin (SA) were excluded. Patients were stratified by normal (>3.0 g/dL) versus low (<3.0 g/dL) SA. The relative impact of SA and body mass index (BMI) (as individual and as combined variables) on surgical morbidity and mortality were assessed. Multivariate analyses were performed to identify independent risk factors for morbidity and mortality.Overall, 2,088 (2.43%) patients had low preoperative SA. 587 (28.1%) patients with low preoperative SA were obese (BMI>30), versus 39,299 (46.9%) with normal preoperative SA. Importantly, the interaction of hypoalbuminemia and BMI was independently associated with all complications among hypoalbuminemic patients with BMI>40, and mortality for patients with BMI>30 after controlling for appropriate demographic characteristics, co-morbidities, surgical wound classification, operation type, and complexity (c-statistic: .803 and .874 respectively).PD and obesity appear to synergistically increase the risk of surgical complications. Paradoxically, malnutrition may be less easily recognized in obese individuals and surgeons may need to more carefully evaluate this population before surgery. Future studies should investigate therapy to correct PD specifically among obese patients before surgery.

SUBMITTER: Dietch ZC

PROVIDER: S-EPMC4408210 | biostudies-literature | 2015 Jul-Aug

REPOSITORIES: biostudies-literature

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Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients.

Dietch Zachary C ZC Guidry Christopher A CA Davies Stephen W SW Sawyer Robert G RG

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 20141023 4

<h4>Background</h4>Protein deficiency (PD) is a known risk factor for surgical complications; however, the risks of PD by weight class have not been well described. It was hypothesized that the combination of obesity and PD is associated with increased surgical complications compared with normal weight and normoalbuminemic patients.<h4>Methods</h4>A total of 85,833 general surgery patients undergoing elective operations within the 2011 National Surgical Quality Improvement Program were analyzed. ...[more]

PMID: 25851777

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Project description:BackgroundTo evaluate effectiveness, safety, and costs of Lorcaserin vs. phentermine among obese non-surgical and surgical patients (post bariatric surgery).MethodsThis retrospective study retrieved charts of all patients (January 2013-June 2016) who received Lorcaserin or phentermine for 3 months. The study assessed anthropometric, glycemic, and lipid changes, as well as side effects and cost of medications among overweight and obese non-surgical (n = 83) and surgical patients (n = 46). These two patient groups were compared using Chi-square (χ2) and unpaired't' test for qualitative and quantitative variables respectively.ResultsAt 3 months, among the non-surgical group, Phentermine patients had greater percentage of total weight loss (TWL%) (7.65 ± 8.26 vs. 2.99 ± 3.72%, P = 0.003), and greater BMI reduction (-3.16 ± 3.63 vs. -1.15 ± 1.53 kg/m2, P = 0.003) than Lorcaserin. Within the surgical group, Lorcaserin patients had significantly smaller TWL% (1.86 ± 5.06 vs. 7.62 ± 9.80%, P = 0.012), and smaller BMI reduction (-0.74 ± 1.80 vs. -3.06 ± 4.08 kg/m2, P = 0.012) than Phentermine. Lorcaserin exhibited significant total cholesterol and LDL improvements only among surgical patients with significant weight reduction (≥5% TW). Both medications were not associated with glycemic improvements among non-surgical and surgical groups. Phentermine had slightly more side effects but was less expensive.ConclusionsAmong both patient groups, phentermine was more effective in achieving weight loss. Lorcaserin showed dyslipidemia improvements only among surgical patients who achieved significant weight reduction. Anti-obesity medications as part of weight management programs can result in weight loss among non-surgical and surgical patients, or halt weight regain among surgical patients. This is the first study to evaluate the effectiveness and safety of two anti-obesity medications (lorcaserin vs. phentermine) among two distinct obese patient groups, non-surgical and surgical patients.

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Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients.

Publications

Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients.

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