ABSTRACT
PURPOSE: The COVID-19 outbreak has forced a 2-month lockdown (LD) in Spain. We aimed to assess how that had affected our cohort of bariatric patients waiting for surgery. METHODS: A review of electronic records and a structured phone interview with each patient were conducted. Changes in severity of obesity were analyzed using the Obesity Surgery Score (OSS) and changes in health-related quality of life (HRQoL) using the validated EQ-5D questionnaire. Other miscellaneous questions about behavior modifications and surgical risk perception were also analyzed. RESULTS: All 51 patients fully answered the questionnaires. Mean age was 47 years and mean time on waiting list 91 days. Mean BMI increased during LD (42.7 vs 43.2; p < 0.001). Both OSS (2.84 vs 3; p = 0.011) and EQ-5D (69 vs 64; p < 0.001) mildly worsened during LD, mainly due to psychosocial issues. Twenty-seven patients (53%) thought that perioperative risks were higher under the current circumstances but they were as willing to undergo surgery as those who believed that the risks had not increased (74% vs 87%, p = 0.2). CONCLUSIONS: COVID-19 LD had a significant but mild effect on our cohort of bariatric surgery waiting list patients. Although perioperative risk perception had increased, patients were still willing to undergo their planned surgeries.
Subject(s)
Bariatric Surgery , COVID-19/prevention & control , Communicable Disease Control , Obesity/psychology , Obesity/surgery , Waiting Lists , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Cohort Studies , Female , Humans , Male , Middle Aged , Obesity/complications , Quality of Life , Risk Assessment , Self Concept , Spain , Surveys and QuestionnairesABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Hernia, Diaphragmatic/complications , Gastric Dilatation/complications , Gastroplasty/methods , Esophagectomy/adverse effects , Hernia, Diaphragmatic/diagnostic imaging , Esophagectomy/methods , Postoperative ComplicationsABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Hernia, Diaphragmatic/complications , Hernia, Diaphragmatic/diagnostic imaging , Intestinal Obstruction/pathology , Radiography, Thoracic , Laparoscopy/methodsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Bile Reflux/surgery , Biliopancreatic Diversion , Cholangitis/surgery , Cholelithiasis/surgery , Duodenum/surgery , Postoperative Complications/surgery , Obesity, Morbid/surgery , Choledochostomy , Abdominal Pain/etiologyABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/secondary , Carcinoma, Renal Cell/surgery , Thyroid Nodule/diagnostic imaging , Prognosis , Tomography, X-Ray Computed/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Intussusception/complications , Lipoma/diagnostic imaging , Lipoma/surgery , Laparoscopy/methods , Gastrostomy/methods , Gastrointestinal Neoplasms/diagnostic imaging , Gastrointestinal Neoplasms/surgery , Tomography, Emission-Computed/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Hemobilia/etiology , Aneurysm, False/complications , Cholecystitis, Acute/complications , Laparoscopy/methods , Hematemesis/etiology , Melena/etiologyABSTRACT
BACKGROUND: In the last decades, we have experienced an increase in the prevalence of obesity in western countries with a higher demand for bariatric surgery and consequently prolonged waiting times. Currently, in many public hospitals, the only criterion that establishes priority for bariatric surgery is waiting time regardless of obesity severity. METHODS: We propose a new, simple, and homogeneous clinical prioritization system, the Obesity Surgery Score (OSS), which takes into account simultaneously and equitably the time on surgical waiting list and the obesity severity based on three variables: body mass index, obesity-related comorbidities, and functional limitations. We have reviewed the current literature related to obesity clinical staging systems, and we have carried out an analysis of our patients in waiting list and divided their characteristics according to their degree of severity (A, B, or C) in the OSS. Patients with OSS grade C have a higher mean BMI, greater severity in comorbidities, and greater socio-labor impact. The current surgery waiting time of our series is of 26 months. Currently, 27 patients (51.9%) with OSS grade B and 15 patients (51.7%) with OSS grade C have been on our waiting list for more than 1 year. CONCLUSION: Since the obesity severity, the waiting time and its clinical consequences are associated with an increase in morbidity and mortality, it is important to apply a structured prioritization system for bariatric surgery waiting list. This allows prioritization of patients at greater risk, improves patient prognosis, and optimizes costs and available health resources.
Subject(s)
Bariatric Surgery , Obesity, Morbid/surgery , Waiting Lists , Humans , Obesity, Morbid/diagnosis , Severity of Illness IndexABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Gastrointestinal Hemorrhage/etiology , Jejunal Neoplasms/surgery , Gastrointestinal Stromal Tumors/surgery , Jejunal Neoplasms/complications , Melena/etiology , Wasting Syndrome/etiologySubject(s)
Carcinoma, Renal Cell/secondary , Kidney Neoplasms/diagnosis , Thyroid Neoplasms/secondary , Thyroid Nodule/diagnostic imaging , Aged , Biopsy, Fine-Needle , Biopsy, Large-Core Needle , Carcinoma, Renal Cell/diagnosis , Female , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Thyroid Neoplasms/diagnosis , Thyroid Nodule/pathology , Tomography, X-Ray Computed , UltrasonographySubject(s)
Colonic Diseases/etiology , Hernias, Diaphragmatic, Congenital/complications , Laparoscopy , Colonic Diseases/diagnostic imaging , Colonic Diseases/surgery , Hernias, Diaphragmatic, Congenital/diagnostic imaging , Hernias, Diaphragmatic, Congenital/surgery , Herniorrhaphy/methods , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Male , Middle Aged , Surgical MeshSubject(s)
Duodenal Diseases/etiology , Duodenal Diseases/surgery , Gastric Mucosa , Intussusception/etiology , Intussusception/surgery , Laparoscopy , Lipoma/complications , Stomach Diseases/etiology , Stomach Diseases/surgery , Stomach Neoplasms/complications , Humans , Laparoscopy/methods , Male , Middle Aged , StomachSubject(s)
Aneurysm, False/etiology , Hemobilia/etiology , Hepatic Artery , Aged , Ampulla of Vater/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy , Cholecystitis/complications , Conversion to Open Surgery , Female , Gallstones/complications , Gallstones/diagnostic imaging , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Hemorrhage/etiology , Hepatic Artery/abnormalities , Hepatic Artery/diagnostic imaging , Hepatic Artery/surgery , Humans , Ligation , MaleABSTRACT
BACKGROUND: Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality of patients submitted to elective nontraumatic splenectomy. METHODS: A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory, and surgical data, histological findings, perioperative mortality, and postoperative complications according to Clavien-Dindo classification, were recorded. Factors related to morbidity and mortality were analyzed. RESULTS: Of the 152 patients (89 male and 63 female; mean age 49.8 ± 17.8 years), 74 (48.7%) were operated on for malignant hematologic disorders, 44 for benign hematologic process, and 34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78 patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was 7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were age (p = 0.004), anemia (p = 0.03), leukocytosis (p = 0.016), and blood transfusions (p < 0.001). In the multivariate analysis, only the need for blood transfusion remained as an independent prognostic factor (p = 0.001). Related to mortality, negative prognostic factors were age (p = 0.003), leukocytosis (p = 0.048), American Society of Anesthesiologists (ASA) score (p < 0.001), blood transfusion (p < 0.001), pleural effusion (p = 0.031), and pneumonia (p = 0.001). Pneumonia remained an independent prognostic factor of mortality (p = 0.024). CONCLUSION: Blood loss is the most important prognostic factor for postoperative complications after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative mortality.
