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PubMed2002

Intermediate results following laparoscopic adjustable gastric banding for morbid obesity.

BACKGROUND/AIMS: Morbid obesity is a rapidly increasing health risk in most industrialized countries. Unfortunately, conservative treatment methods will fail in the long run in almost 100% of patients. Today, long-lasting success can only be achieved by operative treatments. Laparoscopic gastric banding has the general benefits of minimally invasive techniques is relatively easy to perform and can be reversed or changed to any other operation aiming at weight loss, if necessary. We report here our primary and intermediate outcome of Laparoscopic Adjustable Gastric Banding (LAGB). METHODS: Since 1996-2001 we have treated 110 (87 women, 23 men) morbidly obese patients with the Swedish Adjustable Gastric Band (SAGB). Median age (range) of the patients was 42 years (21-64), and preoperative median body mass index (BMI, kg/m(2)) (range) was 44 (35-66). Most of the patients suffered from obesity related co-morbidities. RESULTS: At a median follow-up of 27 months, mean weight loss was 30 kg, mean excess weight loss (range) 52% (11-108%), and median (range) BMI 34 (24-46). Reoperations due to band slippage (3 patients), band erosion (2 patients), infection (1 patient), and leakage of the band or the filling system (5 patients) have been necessary in 11 (10%) patients so far. Median postoperative hospital stay (range) was 3 days (2-53). There was no mortality. Immediate postoperative morbidity was 9%. More than 50% of the patients had signs of mild erosive gastroesophageal reflux disease during routine endoscopic follow-up 3 years after the operation. CONCLUSION: Weight loss following LAGB is generally good and complications few, at least in the short term. However, technical problems with the band causes morbidity and reoperations in a number of patients. Despite this fact, we think the LAGB operation is the best 'first' operation in the treatment of morbid obesity, although long-term results are not yet available.

Adult↗
PubMedDate not supplied

Life expectancy without chronic morbidity: trends in gender and socioeconomic disparities.

OBJECTIVE: Life expectancy without chronic morbidity, or morbidity-free life expectancy (MFLE), was calculated to measure changes in population health status between 1989 and 2000 on the basis of gender and socioeconomic status. METHODS: Sullivan's method was used to calculate morbidity-free life expectancy. Prevalence rates for chronic morbidity were derived from the Netherlands Continuous Health Interview Survey. Four socioeconomic groups were distinguished on the basis of educational level. RESULTS: Between 1989 and 2000, total life expectancy increased for males and females and for all socioeconomic groups. Morbidity-free life expectancy decreased significantly for males (from 54.7 years to 53.9 years) and females (from 55.3 years to 51.0 years). The gap between males and females in MFLE has reversed, from 0.6 years in favor of females in 1989 to 2.9 years in favor of males in 2000. The gap between the upper and lower classes seems to have narrowed (for males from 11 years to 8.5 years and for females from 4.7 years to 4.0 years). CONCLUSIONS: The results indicate that morbidity-free life expectancy is falling for males and females and in all socioeconomic groups. Part of this decrease could be attributed to earlier diagnosis of chronic diseases. A widening gap in MFLE was observed between males and females in favor of males. The gap between the upper and lower socioeconomic groups seems to be narrowing.

Aged↗
PubMed2006

Adenotonsillar surgery in morbidly obese children: routine elective admission of all patients to the intensive care unit is unnecessary.

Morbidly obese children undergoing adenotonsillectomy, often with co-morbid obstructive sleep apnoea, may be considered at a higher risk of postoperative respiratory compromise. This retrospective study aimed to assess the frequency and severity of postoperative respiratory complications in these patients and to identify preoperative risks factors for such morbidity. Medical and nursing chart review of all consecutive elective post-adenotonsillectomy admissions of morbidly obese children (defined as >95th centile for body mass index adjusted for age and gender) to our intensive care unit over a 30-month period was performed. A total of 26 morbidly obese children were identified. The majority (14/26) had an uncomplicated recovery following surgery. Of those cases that required postoperative intervention, 10 patients required supplemental oxygen with or without suctioning and/or repositioning alone, whilst two required continuous positive airway pressure therapy. No patient required re-intubation. An oxygen saturation nadir of < 70% and the presence of more than one central apnoea, noted on preoperative overnight polysomnography, were associated with postoperative respiratory complications requiring intervention. Although the intervention group were younger, more obese and had a higher respiratory disturbance index, none of these factors were statistically significant. Routine admission to the paediatric intensive care unit of all morbidly obese children undergoing adenotonsillectomy may be unnecessary, once a suitable high level of nursing is available in an alternative setting, to administer simple positional and suctioning intervention and to perform regular patient observation. Special consideration should be given to the postoperative nursing environment for those patients with a SaO2 nadir < 70% noted preoperatively, indicating the presence of a significant central disease component.

Adenoidectomy↗
PubMed2004

Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients.

UNLABELLED: Atelectasis caused by general anesthesia is increased in morbidly obese patients. We have shown that application of positive end-expiratory pressure (PEEP) during the induction of anesthesia prevents atelectasis formation in nonobese patients. We therefore studied the efficacy of PEEP in morbidly obese patients to prevent atelectasis. Twenty-three adult morbidly obese patients (body mass index >35 kg/m(2)) were randomly assigned to one of two groups. In the PEEP group, patients breathed 100% oxygen (5 min) with a continuous positive airway pressure of 10 cm H(2)O and, after the induction, mechanical ventilation via a face mask with a PEEP of 10 cm H(2)O. In the control group, the same induction was applied but without continuous positive airway pressure or PEEP. Atelectasis, determined by computed tomography, and blood gas analysis were measured twice: before the induction and directly after intubation. After endotracheal intubation, patients of the control group showed an increase in the amount of atelectasis, which was much larger than in the PEEP group (10.4% +/- 4.8% in control group versus 1.7% +/- 1.3% in PEEP group; P < 0.001). After intubation with a fraction of inspired oxygen of 1.0, PaO(2) was significantly higher in the PEEP group compared with the control group (457 +/- 130 mm Hg versus 315 +/- 100 mm Hg, respectively; P = 0.035) We conclude that in morbidly obese patients, atelectasis formation is largely prevented by PEEP applied during the anesthetic induction and is associated with a better oxygenation. IMPLICATIONS: Application of positive end-expiratory pressure during induction of general anesthesia in morbidly obese patients prevents atelectasis formation and improves oxygenation. Therefore, this technique should be considered for anesthesia induction in morbidly obese patients.

Adult↗
PubMed1991

Symptom sensitivity and sex differences in physical morbidity: a review of health surveys in the United States and The Netherlands.

Health surveys have found higher female morbidity rates, as reflected by indices such as general health status, number of acute conditions or physical symptoms and medical care utilization. Such findings can lead to the conclusion that women are the "sicker sex" in terms of objective health status. However, the size of the sex difference varies with the different indices used to operationalize the morbidity concept. Apart from sex specific conditions, the female morbidity excess seems most substantial with regard to general health status, acute and mild chronic conditions and physical symptoms. Findings from a large health survey in the Netherlands, presented in this article, confirm this picture. Some major methodological sources of bias, that have been held responsible for part of the sex differences found in health surveys, such as the poor definition of the morbidity concept and aspects of the data collection process, are discussed. One explanation for the higher morbidity of women, i.e., the differential perception of physical symptoms by men and women, is elaborated in more detail. The authors suggest that part of the sex differences found in health surveys can be explained by a higher female symptom sensitivity, defined as a readiness to perceive physical sensations as symptoms of illness. Research supporting this symptom sensitivity hypothesis is reviewed and explanations are given. It is suggested that further research on sex differences in morbidity should control for methodological sources of sex bias and should focus explicitly on differences in the perception of physical symptoms by men and women.

Bias↗
PubMed2006

Association between morbidity and skeletal biomarkers of biological aging.

The Osseographic Scoring System (OSS) is a synthetic measure of skeletal aging that combines osteoporotic and osteoarthritic changes of the hand. The OSS is used to evaluate biological age in a population. The aim of the present study was to evaluate the association between certain chronic morbidities and the skeletal biomarker of biological aging. We performed a population-based study on a large sample of individuals who were receiving no medications to treat or prevent chronic morbidities [668 male (age 18-89 years) and 608 female (age 18-81 years) Chuvashians]. Morbidity data obtained from the individuals' medical records was sorted into 16 categories. A one-way ANOVA was used to elucidate the association between morbidity and age-adjusted OSS score. Statistically significant differences between means of OSS scores in affected vs. nonaffected individuals were found in the rheumatic diseases group. Ischemic heart disease, pulmonary diseases, traumatic brain injuries, and gynecological diseases also showed differences; however, after correction for multiple testing, the results were statistically nonsignificant. We conclude that individuals who suffer from the mentioned chronic morbidities will show a higher degree of skeletal aging. Further research is needed to clarify the biological mechanisms of association between certain types of morbidities and changes in skeletal aging.

Adolescent↗
PubMed2001

The role of psychological functioning in morbid obesity and its treatment with gastroplasty.

BACKGROUND: The authors evaluated the psychological characteristics of the morbidly obese. The condition-specific and quality-of-life characteristics of a large sample of vertical banded gastroplasty (VBG) patients were evaluated. The role that these psychological characteristics play in moderating the success of gastroplasty surgery, as well as the impact of surgery on quality of life, was examined. METHODS: This is a cross-sectional evaluative study of a clinical samples, with longitudinal follow-up and with non-surgical comparison groups. 89 morbidly obese individuals were assessed before VBG (but after having been accepted for surgery) and again 1.27 years after surgery. This group represents 98% of the patients who received VBG (i.e., a 2% dropout rate). We used established psychological measures (quality of life, adjustment to obesity, functional impairment, and eating attitudes), including a scale developed by our group specifically for morbid obesity, to identify distinct psychological profiles of the morbidly obese before surgery. RESULTS: The three profile groups differed significantly in psychological characteristics, ranging from high functioning (little emotional distress, functional impairment or dysfunctional eating) to poor functioning (high emotional distress, functional impairment and dysfunctional eating). The subgroups did not differ on pre-surgical weight, and did not differ from morbidly obese groups not seeking surgery. For the surgery group, regardless of pre-surgery psychological profile, VBG produced significant weight loss, maintained at 1 year after surgery. As well, surgery resulted in significant improvements in quality of life and psychological adjustment, especially in the profile group initially presenting with psychological disturbance. CONCLUSION: There was no evidence to suggest that those with pre-surgical psychological difficulties did more poorly with VBG. These data call into question screening out individuals with psychological problems from gastroplasty surgery. Furthermore, psychological difficulties, if they exist, appear more related to the nature of morbid obesity than to the character of the individual. Psychological difficulties pre-surgery were normalized following surgery.

Adolescent↗
PubMed2003

Achalasia in the context of morbid obesity: a rare but important association.

BACKGROUND: The simultaneous occurrence of achalasia and morbid obesity is rare. Nevertheless, the surgical therapy of morbid obesity may be harmful, if undiagnosed achalasia were left untreated. We report the clinical presentation and response to treatment of achalasia in the context of morbid obesity. METHODS: From 1998 to 2002, 638 patients underwent surgery for morbid obesity. Preoperative upper gastrointestinal radiography was performed in all patients. Three patients had manometric confirmation of achalasia. The characteristic symptoms were recurrent episodes of regurgitation, chronic cough and aspiration. No patient reported dysphagia or recent weight loss. RESULTS: All patients had a duodenal switch procedure and in two a concurrent Heller myotomy was added. The other patient required a Heller myotomy after a duodenal switch had been performed, because the motility study was initially misinterpreted. All patients reported gradual resolution of presenting symptoms after myotomy. CONCLUSIONS: A careful symptomatic history focusing on aspiration, regurgitation and cough may identify the unusual combination of achalasia and morbid obesity. Treatment of morbid obesity alone may lead to progression of pulmonary symptoms.

Adult↗
PubMed2003

Low-back pain in morbidly obese patients and the effect of weight loss following surgery.

BACKGROUND: Although low-back pain (LBP) is a common health problem and a source of significant discomfort, disability and work absences, its incidence, severity and outcome have not been extensively investigated in morbidly obese patients undergoing bariatric surgery. METHODS: 50 morbidly obese candidates for vertical banded gastroplasty (VBG) were asked to fill in a questionnaire, to assess the incidence and severity of any existing LBP symptoms. 50 non-obese patients, admitted to our surgical unit for management of several benign conditions, were also asked to fill in the same questionnaire and served as controls. 24 months after VBG, the morbidly obese patients were again evaluated for their LBP symptoms. RESULTS: LBP was identified in 29 morbidly obese patients (58%) preoperatively and in only 12 (24%) of the lean controls (P<0.01). 2 years after VBG, with a significant excess weight loss (P<0.0001), only 10 patients continued to have LBP but less frequently and requiring reduced doses of medications compared with the preoperative condition. In the remaining 19 patients with preoperative positive LBP history, the postoperative weight loss was associated with complete resolution of the symptoms. CONCLUSION: The frequency of LBP is significantly higher in morbidly obese patients than in lean subjects. Surgical weight reduction results in significant improvement and even disappearance of this obesity co-morbidity.

Adult↗
PubMed2004

The evolution of experimental surgery in the field of morbid obesity.

BACKGROUND: We reviewed the experimental surgery, related to bariatric surgery in laboratory animals, to consider new lines of research. METHODS: The literature on experimental surgery for morbid obesity since the mid-20th century was reviewed, focusing on existing techniques (malabsorptive, restrictive, mixed and experimental) and their associated metabolic component. RESULTS: In the field of laparoscopy, there is a clear tendency for large laboratory animals such as pigs to be used. These are useful for developing and perfecting techniques. A second area of animal experimentation concentrates on the relationship between metabolism and surgery in order to find improvements in the co-morbidities associated with morbid obesity. A third area of research focuses on manipulating intake via central and vagal control. CONCLUSION: Further studies are needed to combine traditional and recently developed techniques of experimental surgery with the mechanisms that determine the physiopathology, metabolism and regulation of intake of morbidly obese patients. To accurately determine metabolic behavior and avoid drawing conclusions that are not very significant, these studies should be carried out on obese animals and focus on the co-morbidities associated with morbid obesity.

Animals↗
PubMed2004

Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding.

BACKGROUND: We investigated the reduction in co-morbidities following laparoscopic adjustable silicone gastric banding (LAGB). METHODS: Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m(2) were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately. RESULTS: The preoperative frequencies of co-morbidities were as follows: hypertension 52%, diabetes 20%, dyspnea 85%, peripheral edema 63%, sleep apnea 36%, arthralgia 89%, reflux 57%, reduced self-esteem 95%, reduced general physical performance 96%, hyperlipidemia 39%, hyperuricemia 36%, and menstrual problems 22%. Excess weight loss after 1 year was 40%, after 2 years 46%, after 3 years 47%, and after 4 years 54%. After 4 years, the rate of cure/improvement of the co-morbiditites were: hypertension 58% / 42%, diabetes 75% / 8%, dyspnea 85% / 12%, arthralgia 52% / 24%, reflux 79% / 11%, self-esteem 45% / 39%, and general physical performance 58% / 33%. We also found an improvement in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation. Greater weight loss was associated with greater reduction in dyspnea, arthralgia, self-esteem, and physical performance. Hypertension, diabetes, reflux, and edema improved independent of the amount of weight loss. Reoperated patients undergoing either rebanding or biliopancreatic diversion with duodenal switch had similar weight loss and reduction in co-morbidities as did patients treated with LAGB only. CONCLUSION: With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.

Adolescent↗
PubMed2005

Surgery for morbid obesity: selection of operation based on evidence from literature review.

BACKGROUND: Bariatric surgery is the therapy for morbid obesity. There are a number of surgical procedures, which are performed by open surgery (OS) and more recently also by laparoscopy (LS). The objective of this study was to consider the evidence for the best bariatric surgical options. METHODS: Systematic review of the literature was conducted. Morbid obesity studies published between 1990 and 2002 were analyzed. MEDLINE, LiLACS and COCHRANE databases were used, utilizing MeSH terms and free words. Selected studies were analyzed using a specially designed score of methodological quality, to analyze and compare studies. This validated scale is composed by 3 items, and the final score may range between 6 and 36 points. Means, medians and weighted means were calculated, and a comparative analysis by therapy was performed using median 95% confidence intervals (CI). Number of treated patients, reduction in body mass index (BMI), reduction in co-morbidity, %EWL, morbidity and mortality, hospital stay, follow-up, success and failure of operations, and methodological quality were analyzed. RESULTS: 283 related articles were considered. Only 31 of them had selection criteria (these include 5,216 patients operated by OS and 3,230 by LS). Operative mortality was 0.0% for OS and 0.4% for LS. At 36 months, OS techniques show reduction in BMI, %EWL and reductions in co-morbidity of 30.9%, 61.9% and 74.1% respectively. At 36 months, LS techniques show reduction in BMI, %EWL and reduction in comorbidity of 23.7%, 55.9% and 70.9%. Hospital stay was 3.8 days for LS and 7 for OS. At 2-year follow-up, morbidity was 14.8% for LS and 16.7% for OS, and reoperations were 17.7% for LS and 11.3% for OS. Median score for methodological quality was 13 for OS and 11 for LS. CONCLUSIONS: Methodological quality of primary studies to 2002 has been poor.

Body Mass Index↗
PubMed2006

Health insurance claims data as a means of assessing reduction in co-morbidities 6 months after bariatric surgery.

BACKGROUND: We measured the very short-term change in obesity-related co-morbidities following bariatric surgery. METHODS: Claims data were analyzed for 933 patients aged 18-62 who were covered by one of 11 New York State health plans and underwent bariatric surgery during calendar year 2002. Data covered 6 months before to 6 months after surgery. Logit regression and fixed effects logit regressions were estimated, to analyze change in the following co-morbidities after bariatric surgery: diabetes, hyperlipidemia, hypertension, asthma, sleep apnea, degenerative joint disease, gastroesophageal reflux, and depression. RESULTS: There were statistically significant post-surgery decreases in each outcome studied. Controlling for individual fixed effects, the probability of a diabetes diagnosis fell by 20% after bariatric surgery. The probability of sleep apnea fell by 33%, and the probability of the other obesity-related co-morbidities fell by 11 to 19% at 6 months. CONCLUSION: Claims data are useful for assessing changes in a wide range of co-morbidities following bariatric surgery. The data indicate significant decreases in obesity-related co-morbidities after bariatric surgery, although considerably smaller than those found in previous studies, which underscores the need for randomized controlled trials of bariatric surgery. Limitations of this study include: follow-up only at 6 months, non-experimental data, and an unknown degree of under-reporting of co-morbidities in claims data.

Adolescent↗
PubMed2006

Morbidly obese individuals with impaired fasting glucose have a specific pattern of insulin secretion and sensitivity: effect of weight loss after bariatric surgery.

BACKGROUND: Obesity is often associated with hyper-secrection of insulin. Impaired fasting glucose (IFG) has recently been redefined as a fasting plasma glucose of 5.6-6.9 mmol/L. The aim of this study was to determine whether changes in insulin secretion in morbidly obese persons also commence with normal serum glucose levels. METHODS: 32 morbidly obese subjects were studied before and after bariatric surgery. Measurements were made of glucose tolerance (K(G)), insulin sensitivity (SI), first-phase insulin release and the disposition index (DI) from a frequently sampled intravenous glucose tolerance test. RESULT: In morbidly obese subjects, the SI (P<0.01), DI (P<0.01) and first-phase insulin release (P<0.02) started changing with serum glucose levels considered to be normal (5.00-5.28 mmol/L). K(G) showed a clear slope according to the baseline glycemia status (P<0.05), and it was significantly related with the DI, both before (r=0.76, P<0.001) and after (r=0.57, P=0.002) surgery. Following surgery, all the variables significantly associated with insulin secretion and insulin sensitivity recovered significantly. The most significant changes occurred in morbidly obese individuals with IFG. CONCLUSIONS: Morbidly obese subjects show slopes of insulin sensitivity and insulin secretion in accordance with their baseline serum glucose levels. The fall in first-phase insulin release begins when serum glucose values are considered normal. Morbidly obese persons with the IFG phenotype have a specific pattern of insulin sensitivity and insulin secretion. K(G) clearly discriminates the clinical phenotypes, depending on baseline serum glucose levels.

Adolescent↗
PubMed1999

A prospective cost-effectiveness analysis of vertical banded gastroplasty for the treatment of morbid obesity.

BACKGROUND: Surgical treatment of morbid obesity is gaining in popularity, because conservative treatment is ineffective. However, a cost-effectiveness analysis has never been performed and is the main goal of the present study. METHODS: 21 consecutive morbidly obese patients were tested before and after vertical banded gastroplasty (VBG). Quality of life was assessed with the Nottingham Health Profile and a visual analogue scale. A prevalence-based cost-of-illness analysis of morbid obesity was performed and the cost-effectiveness of VBG assessed. RESULTS: VBG resulted in a significant weight loss and an improved quality of life. The improved quality of life combined with 3.6 life-years gained after VBG resulted in 12 quality adjusted life-years (QALY) gained in a lifelong scenario. Lifelong costs of illness of morbidly obese persons ranged from $8,304 to $9,367. Total direct costs of VBG were $5,865. The percentage of patients performing paid labor increased from 19% before VBG to 48% after VBG, resulting in an average productivity gain of $2,765 per year. In summary, the cost-effectiveness analysis revealed that surgical treatment of morbid obesity by means of VBG saves $4,004 to $3,928 per QALY (overall dominance). CONCLUSION: Because treatment of morbid obesity with VBG results in QALYs gained and less costs, there is no doubt that this procedure should be introduced or continued from a societal point of view.

Adult↗
PubMedDate not supplied

Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients.

INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients) difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate) and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the extended shock pathway. ESWL should not be considered as the first line of treatment in the morbidly obese patients with low caliceal stones where the stone was positioned more than 1 cm from the focal point on the extended shock pathway.

Adolescent↗
PubMed2000

Physician-evaluated and self-reported morbidity for predicting disability.

OBJECTIVES: This study compared the predictive validity of physician-evaluated morbidity and self-reported morbidity on disability among adults. METHODS: Subjects from a large national survey (n = 6913) received a detailed medical examination by a physician and were asked about the presence of 36 health conditions at baseline. Disability measured 10 and 15 years later was regressed on the morbidity measures and covariates with tobit models. RESULTS: Although physician-evaluated morbidity and self-reported morbidity were associated with greater disability, self-reports of chronic nonserious illnesses manifested greater predictive validity. Disability was also higher for obese subjects and those of lower socioeconomic status. CONCLUSIONS: The findings demonstrate the predictive utility of self-reported morbidity measures on functional disability.

Adult↗
PubMed2002

Identifying patients at risk for postprocedural morbidity after treatment of incidental intracranial aneurysms: the role of aneurysm size and location.

OBJECT: A decision to treat incidental intracranial aneurysms (IIAs) relies on understanding the risks of treatment and weighing them against the those of aneurysm rupture. Whereas the natural history of IIAs is currently being studied, the risks associated with treating IIAs and factors associated with poor outcome need to be clearly established. METHODS: In a consecutive series of 125 patients, 160 IIAs were treated either surgically (152 cases) or endovascularly (eight cases). Postprocedural morbidity was defined as a new neurological deficit associated with a score greater than or equal to 3 on the modified Rankin Scale or a score of less than 24 on the Mini-Mental Status Examination. Logistic regression analysis was used to identify predictors of postprocedural morbidity from retrospectively collected data on demographic, clinical, and radiographic characteristics. Treatment of IIAs was not associated with any mortality and was associated with postprocedural morbidity in 17 (13.6%) of 125 patients (early outcome) and eight (6.4%) of patients (late outcome). In the logistic-regression model, treatment of aneurysms (>or=13 mm) and posterior circulation aneurysms were independently associated with postprocedural morbidity. In patients in whom postprocedural neurological deficits developed, 12 (70.6%) of 17 and four (23.5% ) of 17 patients harbored aneurysms with broad or calcified necks, respectively. Age, comorbidities, multiple aneurysms, specific aneurysm location, and history of subarachnoid hemorrhage related to a different aneurysm were not significantly associated with poor outcome. CONCLUSIONS: The authors found that IIAs can be safely and effectively treated without causing mortality and with a lower morbidity rate than previously reported. A combination of radiographic variables may be helpful in identifying patients at risk for postprocedural morbidity.

Adult↗