Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Nov 2008
Use of critical care resources after laparoscopic gastric bypass: effect on respiratory complications.
Before 2005, all subjects undergoing laparoscopic gastric bypass with a body mass index >50 kg/m(2), age >40 years, and documented obstructive sleep apnea (OSA) were admitted to the intensive care unit (ICU) in our institution. Starting in January 2005, only patients with a body mass index >60 kg/m(2) and severe OSA were admitted. This study assessed the incidence of respiratory complications in patients undergoing laparoscopic gastric bypass before and after implementation of the new ICU admission criteria. ⋯ Limiting ICU admission after laparoscopic gastric bypass to patients with a body mass index >60 kg/m(2) and severe OSA did not increase the overall incidence of postoperative respiratory complications or hospital stay.
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Surg Obes Relat Dis · Sep 2008
Comparative StudyMedication use after bariatric surgery in a managed care cohort.
Bariatric surgery has been shown to provide long-term weight loss, in addition to a significant reduction in obesity-related co-morbidities. The primary aim of this study was to describe the medication use and costs within a managed care cohort after bariatric surgery. A secondary aim was to describe the use rates for other health services after bariatric surgery. ⋯ Within this sample, medication use and costs decreased within 6 months of bariatric surgery. Decreases were also noted in the postoperative period in several obesity-related co-morbidities, office visits, emergency room visits, and outpatient visits; however, an increase occurred in inpatient stays after surgery.
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Surg Obes Relat Dis · Sep 2008
Comparative StudyPredictors of nonalcoholic steatohepatitis in patients undergoing bariatric surgery: when is liver biopsy indicated?
Nonalcoholic fatty liver disease is a frequent accompaniment of morbid obesity. A component of nonalcoholic fatty liver disease, steatosis, can, on occasion, lead to nonalcoholic steatohepatitis (NASH). Bariatric surgery has been shown to alter the course of this disease. Intraoperative liver biopsies might identify patients with NASH for more careful follow-up. We sought to determine noninvasive preoperative indicators of NASH. ⋯ NASH is a frequent accompaniment of morbid obesity in patients undergoing bariatric surgery. Univariate and multivariate analyses of the clinical parameters studied could not identify strong predictors of biopsy-verified NASH. Therefore, intraoperative biopsy remains instrumental in diagnosing NASH and providing information for additional follow-up.
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Only limited data exist on the relationship of lung function to patients with extreme obesity. To assess the relationship between lung function tests and clinical characteristics in a cohort of morbidly obese patients undergoing evaluation for bariatric procedures in a university hospital in the United States. ⋯ The mean preoperative spirometry, lung volumes, and gas exchange values were within the established reference ranges. Restrictive ventilatory defects were less common than obstructive ventilatory patterns and were most prominently associated with obesity hypoventilation syndrome.