Mortality in patients with end-stage renal disease and the risk of returning to the operating room after common General Surgery procedures.

BACKGROUND: The prevalence of end-stage renal disease (ESRD) has increased, and there is limited data on the risks faced by this patient population undergoing surgery. METHODS: Using American College of Surgeons National Surgical Quality Improvement Program, we identified common surgical procedures undergone by patients with ESRD. These patients were compared with a matched-control group. A subanalysis was performed to determine the risk factors for returning to the operating room in patients with ESRD. RESULTS: Of the 195,585 patients identified, 1,163 had ESRD. ESRD was associated with increased mortality (odds ratio [OR] 9.05, confidence interval [CI] 4.09 to 20.00) and rates of return to the operating room (OR 2.97, CI 1.99 to 4.46). Returning to the OR was associated with increased operation times (98.9 vs 130.2 minutes, P < .05), mortality (OR 4.35, CI 2.11 to 8.99), and morbidity (OR 7.6, CI 4.68 to 12.41). CONCLUSIONS: Patients with ESRD face greater risks when entering the operating room, and further study is needed to elucidate preventable risk factors.

Limited recovery of ß-cell function after gastric bypass despite clinical diabetes remission.

The mechanisms responsible for the remarkable remission of type 2 diabetes after Roux-en-Y gastric bypass (RYGBP) are still puzzling. To elucidate the role of the gut, we compared ß-cell function assessed during an oral glucose tolerance test (OGTT) and an isoglycemic intravenous glucose clamp (iso-IVGC) in: 1) 16 severely obese patients with type 2 diabetes, up to 3 years post-RYGBP; 2) 11 severely obese normal glucose-tolerant control subjects; and 3) 7 lean control subjects. Diabetes remission was observed after RYGBP. ß-Cell function during the OGTT, significantly blunted prior to RYGBP, normalized to levels of both control groups after RYGBP. In contrast, during the iso-IVGC, ß-cell function improved minimally and remained significantly impaired compared with lean control subjects up to 3 years post-RYGBP. Presurgery, ß-cell function, weight loss, and glucagon-like peptide 1 response were all predictors of postsurgery ß-cell function, although weight loss appeared to be the strongest predictor. These data show that ß-cell dysfunction persists after RYGBP, even in patients in clinical diabetes remission. This impairment can be rescued by oral glucose stimulation, suggesting that RYGBP leads to an important gastrointestinal effect, critical for improved ß-cell function after surgery.

The effects of imposed sedentary behavior and exercise on energy intake in adolescents with obesity.

OBJECTIVE: Exercise has been shown to decrease subsequent energy intake, without modification of appetite, in adolescents who are obese. This study compared the impact of acute exercise with imposed sedentary behaviors on the daily nutritional adaptations and energy balance of youths with obesity. METHODS: Body composition and maximal oxygen uptake were assessed in 10 12- to 15-year-old adolescents with obesity. Energy consumption, appetite, and energy expenditure were assessed during 3 experimental sessions: (1) exercise session (EX), (2) bed rest session (BR), and (3) control session (CON). RESULTS: Total and morning energy expenditures were significantly higher during EX compared to CON and BR sessions (p < .001), and no differences were found during the afternoon energy expenditure between conditions (BR: 1056.5 ± 121.5; CON: 1185.7 ± 173; EX: 996.1 ± 153.4 Kcal). Total energy intake was significantly reduced on EX (p < .001). Dinner energy intake was significantly reduced during EX (491.65 ± 75.74 Kcal) and CON (666.55 ± 152.09 Kcal) compared with BR (818.87 ± 122.97 Kcal) (p < .001). Appetite was not affected. CONCLUSION: Whereas intense exercise reduces daily energy balance in adolescents with obesity by mainly affecting ad libitum dinner energy consumption, imposed sedentary behaviors lead to increased energy intake and then positive energy balance. The impact of exercise or imposed sedentary behaviors on the energy balance of adolescents with obesity is not only related to the exercise-induced energy expenditure, but also to their energy intake.