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PubMed2005

Abdominal wall cellulitis in the morbidly obese.

Currently, almost two-thirds of the US population is either overweight or obese. In addition to non-infectious complications, obesity predisposes to infections, including lower extremity cellulitis. Although cases of abdominal wall cellulitis in the morbidly obese occur, to date there has been no formal address of this syndrome in the literature. We therefore reviewed our clinical experience of abdominal wall cellulitis complicating morbid obesity. A retrospective database search was performed to identify patients with both cellulitis and morbid obesity who were seen at the Mayo Clinic between January 1998 and August 2003. Clinical and microbiologic data were collected for these patients. Of the 260 cases of cellulitis identified, 24 (9.2%) had morbid obesity and abdominal wall cellulitis. The mean age of the 24 patients was 47 (range 22-70) y and over two-thirds of them were females. Their mean body mass index (BMI) was 62.3 (range 39.6-108.6). 17 (70.8%) had a remote history of abdominal surgery. 16 patients required 23 hospitalizations. Five patients developed cellulitis complications and 7 (29.1%) patients had recurrent bouts of cellulitis during the study period. Abdominal wall cellulitis is a unique infectious complication in patients with morbid obesity. Further study is needed to better define the pathogenesis of this illness to develop strategies in treatment and prevention.

Abdominal Wall↗
PubMed1997

Morbidity and growth performance of infants in Madura, Indonesia.

Between January 1987 and July 1988, all children born in two villages on the island of Madura, Indonesia were visited weekly by a field worker trained to interview mothers on disease symptoms. The maximum recall period was 1 week. All infants were measured (weight and height) at monthly intervals. Information on growth and morbidity is analysed for infants from birth until the age of 11 months. Morbidity, defined as acute respiratory tract infection (ARI), diarrhoea, fever and other diseases, is analysed over 4-week periods and related to growth performance. In total, there are 1373 4-week reporting periods with morbidity information from birth to the age of 12 months. Of all the diseases recorded (1021), 47% were ARI, 13% diarrhoea, 14% fever and 26% other diseases. The average (SD) duration of diarrhoea was 7 (11) days, ARI 14 (9) days, fever 6 (4) days and 16 (10) days for other diseases. The most striking results in this analysis are: (i) the lack of a relationship between morbidity and growth (either linear or weight) during the 1st 6 months of life; (ii) the existence of a relationship between illness and weight increment for which only ARI showed significant influence for infants of 6 months and more; (iii) the lack of a relationship between morbidity and linear growth performance at all ages; and (iv) the fact that no cumulative effect of disease on growth performance was found to explain the observations.

Acute Disease↗
PubMed1994

Late results of gastric bypass surgery for morbid obesity.

OBJECTIVE: Morbid obesity (excess body weight of 45.5 kg or 100% over ideal body weight) is associated with > 3-fold increased mortality in men and women and is resistant to dietary intervention. Gastric bypass (GBP) and vertical banded gastroplasty (VBG) are the currently accepted surgical treatments. The purpose of this study was to analyze retrospectively 153 consecutive morbidly obese patients who underwent GBP from 1975-1986 and were followed for a minimum of 5 years. METHODS: Data were analyzed from 1-16 years postoperative comparing preoperative morbidity, operative complications, postoperative morbidity, interval weight loss, maximum weight loss, and weight regain. RESULTS: At the 1- and 5-year intervals, 129 and 86 patients respectively were available for review. Operative mortality was < 1%. Weight loss at 1 year = 48.5 kg rising to 57 kg at 24 months. Statistically significant weight loss of 37.0 kg (19.2 SD)(p < .001) was achieved at 5 years. The mean percent excess body weight lost was 66.4 and 50.9% at 1 and 5 years, respectively. No obesity-related deaths occurred in the follow-up period. Incidence of hypertension, cardiac disease and diabetes was reduced by 25-50% during follow-up. CONCLUSIONS: GBP is a safe and effective operation which achieves sustained weight loss of > 35 kg at 5 years and reduces the complications of morbid obesity.

Adult↗
PubMedDate not supplied

Puerperal morbidity: a neglected area of maternal health in Sri Lanka.

Pregnancy is the period during which a mother prepares herself physically and psychologically for the delivery and care of the offspring. However, during this period the central concern is the welfare of the baby, but not the mother. When the mother and the child subsequently become two separate beings, the mother's health care is totally neglected unless she develops obvious symptoms of gross physiological and psychological abnormalities. This study, which was carried out in three MOH areas of the Kalutara District on maternal morbidity, had two main objectives. The first was to determine the prevalence of puerperal morbidity and the second was to identify characteristics of those with high levels of morbidity. Of the mothers who are registered by the PHM of the study area 600 were selected for this study. Data were collected using structured interviews conducted within the first week after puerperium (43-50 days after delivery). The morbidity rate revealed by the study is much higher than expected. Excessive bleeding from the vagina was reported by 40 per cent of mothers, while minor symptoms like breast engorgement and chills were reported by many mothers. Only 11 per cent of the mothers in the study did not have any symptoms or signs of ill health, and the rest reported one or more illnesses. Primae gravidae and those who experienced pregnancy wastage during an early pregnancy had a higher morbidity.

Adult↗
PubMed2006

Analysis of stone disease in morbidly obese patients undergoing gastric bypass surgery.

BACKGROUND AND PURPOSE: Recent studies have demonstrated a higher incidence of nephrolithiasis in the morbidly obese. Nephrolithiasis also has been described as a potential outcome after gastric bypass surgery. This is the first study to our knowledge that examines the incidence of nephrolithiasis in the morbidly obese in the setting of gastric bypass surgery at a tertiary referral center. PATIENTS AND METHODS: We retrospectively reviewed the records of patients undergoing laparoscopic gastric Roux-en-Y bypass surgery for morbid obesity at our institution for the incidence of nephrolithiasis preoperatively, de novo stones postoperatively, and both preoperative and postoperative stone formation. RESULTS: Of the 972 patients who underwent a laparoscopic gastric bypass for the treatment of morbid obesity between 1990 and the present, 85 (8.8%) were found to have upper urinary-tract calculi preoperatively, and 32 (3.2%) had de novo stones postoperatively. Of those 85 who had stones preoperatively, 26 (31.4%) developed recurrent stones postoperatively. CONCLUSIONS: These results support findings in the current literature that nephrolithiasis has a higher incidence in the morbidly obese population. The combination of preoperative stone history and gastric bypass surgery may place patients at a higher risk of future stone formation. This latter group of patients should be screened for postoperative stone formation.

Adult↗
PubMed1995

Regression of hepatic steatosis in morbidly obese persons after gastric bypass.

Morbid obesity has been associated with hepatic steatosis and occasional cirrhosis. Despite producing weight loss, intestinal bypass procedures formerly performed to correct morbid obesity, often worsened steatosis and fibrosis, and occasionally resulted in hepatic failure. Current surgical procedures of choice for morbid obesity involve gastric bypass with gastrojejunostomy. Ninety-one liver biopsies taken at the time of gastric bypass for morbid obesity (mean body weight 125.8 kg), and 106 biopsies taken from the same patients from 2 to 61 months later (mean body weight 89.4 kg) were studied. Steatosis and perisinusoidal fibrosis were assessed in histologic sections. Serum albumin, alkaline phosphatase, aspartate aminotransferase (AST), and total bilirubin levels were measured before most biopsies were taken. Both pre- and post-gastric bypass hepatic steatosis varied directly with body weight (r = .5231, P < .001). Steatosis varied inversely with length of time after gastric bypass (r = .4590, P < .001). Of the original biopsies, 37% had lipid vacuoles in at least 26% of hepatocytes. After gastric bypass, 65 patients had reduced steatosis, 18 patients with no steatosis, and 5 patients with minimal steatosis had no change, and 3 patients had increased steatosis. Pre-gastric bypass biopsies from 13 patients had perisinusoidal fibrosis (PSF) that was marked with bridging in three patients, was moderate in one patient, and slight in nine patients. Following gastric bypass, PSF was eliminated in 10 patients, reduced in one patient, and the same in two patients. One patient developed PSF after gastric bypass. Of the three patients who had undergone previous intestinal bypass procedures, two had slight PSF in the biopsies taken at the time of gastric bypass, and one of these had slight PSF in the follow-up biopsy. Serum biochemical abnormalities tended to be slight. Before gastric bypass, serum albumin was low in 11% of cases, alkaline phosphatase was high in 14% of cases, AST was high in 11% of cases, and total bilirubin was high in 1% of cases. After gastric bypass, there was a small reduction in mean serum albumin from 43 g/L before to 41 g/L afterward (P < .05), and a slight rise in mean total bilirubin from 7.0 mumol/L before to 9.6 mu mol/L afterward (P < .01). Most hepatic fatty change and probably some PSF occurring in morbidly obese persons is reduced or eliminated with weight loss following gastric bypass surgery.

Adolescent↗
PubMed1996

Socio-economic status, chronic morbidity and health services utilization by families.

BACKGROUND: This study deals with the perception of the burden of chronic morbidity in general practice. A married couple of general practitioners work in two primary health centres in Madrid (Spain), with populations of different socio-economic status: one deprived, another of medium and high class. OBJECTIVE: The couple try to understand their feelings about a higher prevalence and severity of chronic morbidity in the poor district. METHOD: A transversal observational study was designed. A total of 119 patients aged 50-70 years were interviewed after the medical encounter. Data were obtained about (i) patients' sociodemographic conditions; (ii) structure and economic status of the families; and (iii) chronic morbidity and health services utilization of family members. RESULTS: Families in the deprived district included members of more than two generations in 76.5% of cases (18.8% in the comparison district); 70.3% of the heads of the families (main economic support) were pensioners in the poor district (23.7% in the comparison district); patients in the deprived district have more contacts with the health system and more chronic morbidity; families in the poor area have less expressiveness and cohesion and more irritability and negation. CONCLUSION: Perceived morbidity in general practice is a mix of social and family problems as well as number and severity of chronic health problems and health services utilization.

Aged↗
PubMed1999

The prognostic value of gastrointestinal morbidity for gastric cancer.

OBJECTIVE: A history of gastrointestinal disease is a risk factor for organic gastrointestinal disorders overall. We conducted a retrospective case-control study to explore whether a history of gastrointestinal disease is of prognostic value for gastric cancer. METHODS: Forty-six patients with gastric cancer were identified from a dynamic population of approximately 12,000 patients followed since 1971 in four general practices. The control subjects without gastric cancer were matched one-on-one according to age, general practice, sex and observation period. Data on gastrointestinal morbidity in the period before gastric cancer was diagnosed were obtained from the Continuous Morbidity Registration. RESULTS: The mean observation period between the date of enrolment in the registration and the first diagnosis of gastric carcinoma was 12 years. Although every patient with gastric cancer ultimately will develop gastrointestinal complaints, 28 of these patients had no previous gastrointestinal morbidity, in comparison with 26 control subjects. Furthermore, patients who developed gastric cancer did not have more frequent gastrointestinal morbidity in their past than the control subjects (odds ratio 0.80, 95% CI 0.32-2.03). CONCLUSIONS: Our results suggest that a history of gastrointestinal morbidity is not of prognostic value for gastric cancer. Focusing attention on patients with a past history of gastrointestinal symptoms to detect gastric cancer may be of little value.

Aged↗
PubMed1992

Morbidity from childhood to adulthood. The medical life history of 103 patients.

The aim of the study was to investigate the relationship between presented morbidity in consecutive periods of time in the first 35 years of life. Data were collected in a large rural general practice from 1946 to 1990 and covered 103 persons born between 1946 and 1959 in a general practice in the east of The Netherlands. Morbidity scores were calculated for all registered diagnoses in 5-year periods. Morbidity was allocated to three degrees of seriousness, to all atopic disorders, and to eight important diagnosis groups. There were strong correlations between consecutive time periods for all but serious morbidity. The same pattern was found between 0-4 years of age and consecutive periods till the age of 20-25. After this age no significant correlations could be established. Atopic disorders were inter-related in the first 20 years of life. Strong correlations were also found for eczema and lower respiratory tract infections in the first 20 years, while strong correlations were found for accidents and nervous complaints between the ages of 20 and 35. We conclude that causes of morbidity presented in general practice in childhood and adulthood are strongly inter-related over consecutive 5-year periods.

Adolescent↗
PubMed1993

Child morbidity patterns in two tropical seasons and associated mortality rates.

Cross-sectional morbidity recorded during two successive quarterly survey rounds and subsequent 27-months mortality were studied in a random sample of 4238 preschool children in a rural Zairian area. Analysis focuses on morbid patterns, i.e. any combination of the principal signs and symptoms encountered in tropical areas (oedema, marasmus, cough, fever, diarrhoea and tachypnoea). Almost half the children (45-48%) had signs of morbidity, a very high rate. The 3-6 month age group emerged as particularly vulnerable with the highest prevalences of all morbid patterns except for isolated fever. Isolated cough was more prevalent in the dry season probably as an effect of nightly indoor woodburning. All other morbid patterns were significantly more prevalent in the rainy season. Diarrhoea with cough was found to constitute half of all cases of diarrhoea. The results show that with a few simple questions on major symptoms and a brief examination by paramedical health workers, children with an increased risk of death can be identified. The method can be applied at under-5 clinics. Prognosis is particularly bad in severe malnutrition, especially when associated with diarrhoea, in diarrhoea with cough, cough with fever/tachypnoea and for children who are found sick both in the rainy and the subsequent dry season.

Child, Preschool↗
PubMed1997

Surgical treatment for morbid obesity.

Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons. The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome. While serious peri- and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight. Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.

Diet↗
PubMed2001

Winter excess morbidity: is it a summer phenomenon?

BACKGROUND: It was hypothesized that winter excess mortality is a feature of ill health produced by exposure to ambient low temperatures, and will be matched by winter excess morbidity. The aim of the study was to test the prediction that winter excess morbidity would be observable and would show a social class gradient with greater excesses in less affluent groups, who are less able to heat their houses or whose lack of a car exposes them more frequently to outdoor cold exposure. METHODS: The study was set in the Metropolitan Borough of Stockport and documented, from routine health services hospital admissions data, winter and summer differences in ACORN-specific, age- and sex-standardized hospital admission rates and ratios, for ischaemic heart disease, directly and indirectly standardized using the Stockport population as the standard. RESULTS: The expected social class gradient in ischaemic heart disease admissions was more clearly observable in the summer than in the winter. Affluent groups showed winter excess morbidity, less affluent groups showed summer excess morbidity. CONCLUSION: The data serendipitously indicate an alternative hypothesis - that winter excess morbidity is a feature of health benefits derived in the summer and differentially available to the more affluent, such as opportunities for outdoor leisure. This hypothesis deserves testing in a study designed for that purpose, although it is not entirely satisfactory as an explanation of existing data.

Cold Temperature↗
PubMed1990

A 10-year review of morbidity from childhood preventable diseases in Nigeria: how successful is the expanded programme on immunization (EPI)? An update.

Morbidity and mortality in children of developing countries are primarily due to preventable infectious diseases such as measles, poliomyelitis, tuberculosis, whooping cough, diphtheria, and tetanus. By 1990 WHO hopes to have every child in the world immunized against these six diseases, that was why the Expanded Programme on Immunization (EPI) was launched. In Nigeria, a nationwide execution of EPI began in 1979. In view of the huge population of Nigeria, an evaluation of the efficiency of the EPI programme at reducing morbidity and mortality from the six target diseases has national and global importance. One such analysis of disease trends showed that apart from tuberculosis and acute poliomyelitis there was no clear reduction in morbidity from the EPI target diseases between 1979 and 1983. The programme was revised and relaunched nationwide in 1984. This paper attempts to update documented programme achievements by including information on EPI diseases from 1974 to 1988. An analysis of available data shows that there has been clear reduction in morbidity from measles and whooping cough since 1986, and that the incidence of tuberculosis is on the increase from 1984, despite a national BCG coverage of over 80 per cent. It is suggested that future evaluations should include data on community-based surveys on poliomyelitis and neonatal tetanus, and use the technique of decision analysis to estimate EPI impact on mortality. A similar effort in this paper predicted a 42 per cent morbidity and 37 per cent mortality reductions from EPI target diseases in Nigeria by the end of 1989.

Child↗
PubMed1993

Morbidity and mortality after radical and palliative pancreatic cancer surgery. Risk factors influencing the short-term results.

OBJECTIVE: To analyze the morbidity and mortality after radical and palliative pancreatic cancer surgery in Norway, especially the risk factors. SUMMARY BACKGROUND DATA: A prospective multicenter study between 1984-1987 including only histologically or cytologically verified adenocarcinoma of the pancreas (N = 442) or the papilla of Vater (N = 30); 84 patients (19%) with pancreatic carcinoma and 24 patients (80%) with papilla carcinoma underwent radical operations. A palliative procedure was performed in 252 patients (53%). METHODS: Clinical data, surgical procedures and the following morbidity and mortality were recorded on standardized forms. The risk factors were analyzed by a logistic multiple regression model. RESULTS: The morbidity, reoperation, and mortality rates were 43, 18, and 11% after radical surgery and 23, 4, and 14% after palliative surgery. Karnofsky's index was the sole independent risk factor for death after radical surgery. Splenectomy, age, and TNM stage influenced morbidity. Diabetes, Karnofsky's index, and liver metastases were risk factors in palliative surgery. CONCLUSIONS: The morbidity and mortality risks were comparable between total pancreatectomy and a Whipple's procedure and between biliary and a double bypass. Preoperative biliary drainage had no impact on the risks and may be abandoned. High age is a relative and a low Karnofsky's index an absolute contraindication for radical surgery. Nonsurgical palliation of jaundice should be considered according to the presence of independent risk factors.

Adenocarcinoma↗
PubMed2003

Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients.

OBJECTIVE: To evaluate early and late morbidity of laparoscopic adjustable gastric banding for morbid obesity and to assess the efficacy of this procedure by analyzing its results. SUMMARY BACKGROUND DATA: Laparoscopic adjustable gastric banding is considered the least invasive surgical option for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. It is potentially reversible and safe; major morbidity is low and there is no mortality. METHODS: Between April 1997 and June 2001, 500 patients underwent laparoscopic surgery for morbid obesity with application of an adjustable gastric band. There were 438 women and 62 men (sex ratio = 0.14) with a mean age of 40.4 years. Preoperative mean body weight was 120.7 kg and mean body mass index (BMI) was 44.3 kg. m. RESULTS: Mean operative time was 105 minutes, 84 minutes during the last 300 operations. Mean hospital stay was 4.5 days. There were no deaths. There were 12 conversions (2.4%), 2 during the last 300 operations. Fifty-two patients (10.4%) had complications requiring an abdominal reoperation. Forty-nine underwent a reoperation for minor complications: slippage (n = 43, incisional hernias (n = 3), and reconnection of the catheter (n = 3). Three patients underwent a reoperation for major complications: gastroesophageal perforation (n = 2) and gastric necrosis (n = 1). Seven patients had pulmonary complications and 36 patients experienced minor problems related to the access port. At 1-, 2-, and 3-year follow-up, mean BMI decreased from 44.3 kg. m to 34.2, 32.8, and 31.9, respectively, and mean excess weight loss reached 42.8%, 52%, and 54.8%. CONCLUSIONS: Laparoscopic adjustable gastric banding is a beneficial operation in terms of excessive weight loss, with an acceptably low complication rate. It can noticeably improve the quality of life in obese patients. Half of the excess body weight can be effortlessly lost within 2 years.

Adult↗
PubMed2004

Morbidity in schistosomiasis: an update.

PURPOSE OF REVIEW: Schistosomiasis is an important poverty-related health problem and more than 200 million people are infected. This review summarizes papers from April 2003 to June 2004 with a focus on schistosomiasis morbidity and the various factors that affect the level of morbidity in endemic populations. The aim is to provide an update on the current state of knowledge and, hopefully, thereby stimulate continued research interest in this important area. RECENT FINDINGS: Research into the immune responses associated with severe morbidity has provided new insights into the mechanisms of immune regulation as well as the role of genetic predisposition to periportal fibrosis. Malaria and schistosomiasis are co-endemic and co-infection with malaria may increase the level of morbidity in hepatosplenic schistosomiasis, and alter the host immune response towards schistosome antigens. Schistosome infections may render the host more susceptible to human immunodeficiency virus infection by either interfering with immune responses or increasing the risk of transmission due to genital lesions. An important advance in schistosomiasis research, and parasite genomics, is the recent availability of two major Schistosoma mansoni and Schistosoma japonicum DNA bioinformatic resources. SUMMARY: Significant advances have been achieved in our understanding of the epidemiology, immunology and genetics of schistosomiasis, and the various factors that may influence morbidity. However, good research is vital for sustainable disease control, and continued progress requires a critical mass of researchers with a range of expertise from basic parasite biology to public-health interventions. It is therefore important to strengthen research capacity in endemic countries.

Animals↗
PubMed1997

Avoidable morbidity in infants. A classification based on diagnoses in administrative databases.

OBJECTIVES: A hierarchical classification for avoidable morbidity in infants was developed based on a conceptual model for causes of morbidity. Experts rated the impact of risk factors and health services on diseases coded according to the International Classification of Diseases, 9th Revision, Classification Modification (ICD-9-CM). An etiologic framework was chosen for the classification because knowledge of etiology often suggests strategies for prevention. Causes of morbidity that cluster on the basis of similar risk factors might be avoided using similar strategies. METHODS: Diseases (346 different diagnoses) were rated by 16 general pediatricians; 12 attributes were considered, including the impact on disease occurrence and on severity of five risk factors, preventive health services, and medical treatment. Raters evaluated the impact of health services, constitutional risk factors, and environmental risk factors without regard for service site (eg, inpatient, emergency department, primary care office). Environmental risk factors categories, including family, social, and physical environments, were rated separately. The impact of health services was rated on prevention, treatment, and complications of care. RESULTS: Only ratings indicating that the impact of a risk factor category was substantial were used for the final classification of 275 diagnoses. Consistent with the multifactorial etiology of many diseases, many diagnoses had ratings indicating substantial impact of multiple risk factors. Five mutually exclusive clusters were derived from the 12 ratings based on factor analysis and recognized strategies for prevention. Ordered by level of avoidability, these clusters were termed vaccine-preventable, health-care quality indicators, environmental, environmental/constitutional, and constitutional. CONCLUSIONS: The usefulness of this classification for policy-oriented epidemiologic and health services research is grounded in the premise that prevention is the cardinal objective of child health policy. Cluster-specific hospitalization rates, ie, rates aggregated for all diagnoses falling in a cluster, might be used for allocating resources to interventions directed at environmental or health service determinants of morbidity. Widespread use of ICD-9-CM codes in hospital discharge and ambulatory databases suggests many potential applications for this classification of morbidity burden in population groups.

Databases, Factual↗
PubMed1997

Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion.

STUDY DESIGN: Retrospective study of 184 autologous iliac crest bone grafts used for anterior cervical fusion in 144 procedures. OBJECTIVES: To evaluate the effect of autologous iliac crest bone graft harvest site on operation and recovery and to identify patients at risk for harvest morbidity. SUMMARY OF BACKGROUND DATA: Although autologous iliac crest bone graft is considered the most successful grafting material, concerns about harvest morbidity provide a rationale for considering allograft. Data about the use of autograft therefore would assist spinal surgeons in selecting the appropriate substrates for fusion after anterior cervical decompression. METHODS: Statistical analysis based on patient gender, smoking history, obesity, and medical or pharmacologic risk factors for wound healing was used to evaluate morbidity after patient interviews and examinations. Limited assessment of radiographic outcome also was performed. RESULTS: A second operation because of donor site morbidity was performed in four patients (2.8%), but only one (0.7%) with meralgia paresthetica had permanent sequelae. Superficial wound infection or dehiscence occurred in 5.6% of patients, with a disproportionate number of women, obese patients, and those with medical risk represented. Protracted wound symptoms of pain and poor cosmesis were reported in 2.8% and 3.5% of patients, respectively, and also were found in a significant number of female and obese patients. Evidence of fusion was present in 97% of cases. CONCLUSION: Autologous iliac crest bone graft harvest results in minimal major morbidity when regional anatomy is respected and careful technique is observed. The identification of patients at risk for minor complications suggests that allograft may be appropriate in these patients; however, prospective comparison is required to identify whether graft material or technical factors determine fusion success and relative benefit.

Adult↗