Archives for October, 2009
Oct 24, 2009 | Complications of Diabetes
Spectrum and Risk Factors of Complications After Gastric Bypass
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Spectrum and Risk Factors of Complications After Gastric Bypass
Guilherme M. Campos, MD, PhD; Ruxandra Ciovica, MD; Stanley J. Rogers, MD; Andrew M. Posselt, MD, PhD; Eric Vittinghoff, PhD; Mark Takata, MD; John P. Cello, MD
Arch Surg. 2007;142(10):969-975.
ABSTRACT
Objective To study the spectrum of and risk factors for complications after gastric bypass (GBP).
Design Prospective cohort study.
Setting Academic tertiary referral center.
Patients All morbidly obese patients who underwent open or laparoscopic GBP between January 2003 and December 2006.
Main Outcome Measures Complications were stratified by grade: grade I, only bedside procedure; grade II, therapeutic intervention but without lasting disability; grade III, irreversible deficits; and grade IV, death. Data were analyzed using logistic regression to identify independent risk factors of complications after GBP. Predictors investigated were age, race, sex, marital and insurance status, body mass index, obesity-associated comorbidities, American Society of Anesthesiologists Physical Status Class, operating room time, open or laparoscopic approach, and surgeon experience.
Results Of the 404 morbidly obese patients who underwent consecutive open (n = 72) or laparoscopic (n = 332) GBP, 74 (18.3%) experienced 107 complications. Grade I and II complications were more frequent after open GBP (grade I, 19.4% after open vs 3.9% after laparoscopic operations, P < .001; grade II, 20.8% after open vs 8.4% after laparoscopic operations, P < .001), and 55% were wound related. Grades III and IV complications occurred in only 4 patients (1%), and frequency was similar for open and laparoscopic cases. Three factors were independently predictive of complications: diabetes mellitus (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3; P = .02), early surgeon experience (OR, 2.5; 95% CI, 1.4-4.2; P = .001), and open approach (OR, 3.9; 95% CI, 2.1-7.3; P < .001).
Conclusions Complications occurred in 18.3% of patients, but 95% were treated without leading to lasting disability.
Presence of diabetes, early surgeon experience, and an open approach are risk factors of complications.
There is also 58% increased chance of suicide among GB recipients.
NIH complication rate from 20-40%
New Jersey study 10% surgery for bowel obstruction
Acute Kidney function problems 8.5%
I’m not suprised..DM complicates and is a risk factor for many things
Oct 24, 2009 | Complications of Diabetes
Spectrum and Risk Factors of Complications After Gastric Bypass
This Article
•Abstract
•PDF
•Send to a friend
•Save in My Folder
•Save to citation manager
•Permissions
Citing Articles
•Citation map
•Citing articles on HighWire
•Citing articles on ISI (5)
•Contact me when this article is cited
Related Content
•Related article
•Similar articles in this journal
Topic Collections
•Public Health
•Obesity
•Bariatric Surgery
•Gastrointestinal/ Upper Foregut
•Alert me on articles by topic
Social Bookmarking
Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati
What’s this?
Spectrum and Risk Factors of Complications After Gastric Bypass
Guilherme M. Campos, MD, PhD; Ruxandra Ciovica, MD; Stanley J. Rogers, MD; Andrew M. Posselt, MD, PhD; Eric Vittinghoff, PhD; Mark Takata, MD; John P. Cello, MD
Arch Surg. 2007;142(10):969-975.
ABSTRACT
Objective To study the spectrum of and risk factors for complications after gastric bypass (GBP).
Design Prospective cohort study.
Setting Academic tertiary referral center.
Patients All morbidly obese patients who underwent open or laparoscopic GBP between January 2003 and December 2006.
Main Outcome Measures Complications were stratified by grade: grade I, only bedside procedure; grade II, therapeutic intervention but without lasting disability; grade III, irreversible deficits; and grade IV, death. Data were analyzed using logistic regression to identify independent risk factors of complications after GBP. Predictors investigated were age, race, sex, marital and insurance status, body mass index, obesity-associated comorbidities, American Society of Anesthesiologists Physical Status Class, operating room time, open or laparoscopic approach, and surgeon experience.
Results Of the 404 morbidly obese patients who underwent consecutive open (n = 72) or laparoscopic (n = 332) GBP, 74 (18.3%) experienced 107 complications. Grade I and II complications were more frequent after open GBP (grade I, 19.4% after open vs 3.9% after laparoscopic operations, P < .001; grade II, 20.8% after open vs 8.4% after laparoscopic operations, P < .001), and 55% were wound related. Grades III and IV complications occurred in only 4 patients (1%), and frequency was similar for open and laparoscopic cases. Three factors were independently predictive of complications: diabetes mellitus (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3; P = .02), early surgeon experience (OR, 2.5; 95% CI, 1.4-4.2; P = .001), and open approach (OR, 3.9; 95% CI, 2.1-7.3; P < .001).
Conclusions Complications occurred in 18.3% of patients, but 95% were treated without leading to lasting disability.
Presence of diabetes, early surgeon experience, and an open approach are risk factors of complications.
There is also 58% increased chance of suicide among GB recipients.
NIH complication rate from 20-40%
New Jersey study 10% surgery for bowel obstruction
Acute Kidney function problems 8.5%
I’m not suprised..DM complicates and is a risk factor for many things
Oct 24, 2009 | Signs Symptoms of Diabetes
Routine testing is done for Gestational Diabetes because there are usually no signs or symptoms. Some of the typical signs of diabetes, such as frequent urination, vision problems, and increased hunger are also typical signs of pregnancy so are not reliable in diagnosing GD. Some type of screening for GD is typically done around 24-28 weeks gestation. I had GD with my last pregnancy 10 years ago and I have recently been diagnosed with Glucose Intolerance, a pre-diabetic condition. One of the risks of having GD is developing Type 2 Diabetes later in life.
Oct 24, 2009 | Signs Symptoms of Diabetes
Routine testing is done for Gestational Diabetes because there are usually no signs or symptoms. Some of the typical signs of diabetes, such as frequent urination, vision problems, and increased hunger are also typical signs of pregnancy so are not reliable in diagnosing GD. Some type of screening for GD is typically done around 24-28 weeks gestation. I had GD with my last pregnancy 10 years ago and I have recently been diagnosed with Glucose Intolerance, a pre-diabetic condition. One of the risks of having GD is developing Type 2 Diabetes later in life.
Oct 21, 2009 | Diabetes Excessive Thirst
Does anyone know what excessive thirst is caused by? In the last 3 days i have drank like 2 1/2 to 3 gallons of tea and water. I have to have a drink every second of the day. If i go without drinking for more than an hour I feel sick. Does anyone know if this is normal, or is it a sign of something? I have been tested for diabetes and it was negitive. Could there be something else?
How can it be normal? I drink at least 5 glasses of liquid an HOUR. sometimes more! I’ve been tested for diabetes and anemia. I dont know i used to only drink like maybe 5 glasses of water a day.
I’m not really sure how much i pass at a time, but sometimes i have to go like 2-3 times an hour. Which may not be alot, but i used to go like 2-3 times a day. I wake up maybe 3 times a night to go.
Polydipsia or excessive thirst is frequently caused by sugar problems (diabetes and insulin resistance) but not always.
You might be sodium deficient. Are you on medication that could cause this?
Check out the links below to see if they apply.
Oct 21, 2009 | Diabetes Excessive Thirst
Does anyone know what excessive thirst is caused by? In the last 3 days i have drank like 2 1/2 to 3 gallons of tea and water. I have to have a drink every second of the day. If i go without drinking for more than an hour I feel sick. Does anyone know if this is normal, or is it a sign of something? I have been tested for diabetes and it was negitive. Could there be something else?
How can it be normal? I drink at least 5 glasses of liquid an HOUR. sometimes more! I’ve been tested for diabetes and anemia. I dont know i used to only drink like maybe 5 glasses of water a day.
I’m not really sure how much i pass at a time, but sometimes i have to go like 2-3 times an hour. Which may not be alot, but i used to go like 2-3 times a day. I wake up maybe 3 times a night to go.
Polydipsia or excessive thirst is frequently caused by sugar problems (diabetes and insulin resistance) but not always.
You might be sodium deficient. Are you on medication that could cause this?
Check out the links below to see if they apply.
Oct 21, 2009 | Diabetes Blurred Vision
Our office receptionist has been getting the signs of diabetes (thirsty, going to the loo a lot, blurred vision, headaches, tiredness) for the last week, and she has a history in the family. I am concerned, both as a friend, and as one of the company First Aiders. How quickly should she be getting to a dr (she "doesn’t want to make a fuss"), and, more importantly, how long, if she leaves it, would it be before something major happens?
How long can’t be guessed. She could suddenly have very serious and emergent problems or have the signs come and go or anything in between. It could change to sudden also. She shouldn’t wait. The longer she goes with even minr symptoms, the more likely to she can have related problems which may not be reversible or create chronic health problems. p.s. – urine testing gives only indicator signs to doctors, it is not used to diagnose diabetes. Blood testing and glucose tolerance testing are used for diagnosis.
Oct 21, 2009 | Diabetes Blurred Vision
Our office receptionist has been getting the signs of diabetes (thirsty, going to the loo a lot, blurred vision, headaches, tiredness) for the last week, and she has a history in the family. I am concerned, both as a friend, and as one of the company First Aiders. How quickly should she be getting to a dr (she "doesn’t want to make a fuss"), and, more importantly, how long, if she leaves it, would it be before something major happens?
How long can’t be guessed. She could suddenly have very serious and emergent problems or have the signs come and go or anything in between. It could change to sudden also. She shouldn’t wait. The longer she goes with even minr symptoms, the more likely to she can have related problems which may not be reversible or create chronic health problems. p.s. – urine testing gives only indicator signs to doctors, it is not used to diagnose diabetes. Blood testing and glucose tolerance testing are used for diagnosis.
Oct 21, 2009 | Signs of Gestational Diabetes
I have been craving sugar throughout my whole pregnancy and I’ve been eating a lot of candy lately, been trying to stop. I’m 26 weeks and I have my prenatal appt on wednesday to do the one hour test. I am far from overweight (5’4 127 lbs), obesity does not run in my family, and i dont have PCOS. (I heard all of these things increases the risk). However I have been urinating A LOT which i heard is a sign. Are my chances high?
Here’s how it works: eating sugar can’t case you to get gestational diabetes. It’s a genetic predisposition and there’s no way to tell completely that you will get it or not – you can guess by risk factors, but it’s not a guarantee.
However, if you have that genetic disposition, eating too much sugar will DEFINITELY affect whether you get high blood sugars during pregnancy. In other words, you could be predisposed for GD but if you ate like a gestational diabetic throughout your whole pregnancy you could avoid high blood sugars and would only show high on the actual test. The test would force it to show up because it’s a big dose of sugar/glucose all at once that measure how you react to sugar.
If you don’t have the predisposition for it and eat sugar all the time it will be bad for your teeth and weight gain, but your blood sugar will never go high. Your body manufactures enough insulin to cover as much sugar as you eat.
You don’t have to be overweight. A common indicator is if someone in your family tree is a type 2 diabetic, and certain ethnicities are more prone that others like Native Americans. Good luck!
Oct 21, 2009 | Signs of Gestational Diabetes
I have been craving sugar throughout my whole pregnancy and I’ve been eating a lot of candy lately, been trying to stop. I’m 26 weeks and I have my prenatal appt on wednesday to do the one hour test. I am far from overweight (5’4 127 lbs), obesity does not run in my family, and i dont have PCOS. (I heard all of these things increases the risk). However I have been urinating A LOT which i heard is a sign. Are my chances high?
Here’s how it works: eating sugar can’t case you to get gestational diabetes. It’s a genetic predisposition and there’s no way to tell completely that you will get it or not – you can guess by risk factors, but it’s not a guarantee.
However, if you have that genetic disposition, eating too much sugar will DEFINITELY affect whether you get high blood sugars during pregnancy. In other words, you could be predisposed for GD but if you ate like a gestational diabetic throughout your whole pregnancy you could avoid high blood sugars and would only show high on the actual test. The test would force it to show up because it’s a big dose of sugar/glucose all at once that measure how you react to sugar.
If you don’t have the predisposition for it and eat sugar all the time it will be bad for your teeth and weight gain, but your blood sugar will never go high. Your body manufactures enough insulin to cover as much sugar as you eat.
You don’t have to be overweight. A common indicator is if someone in your family tree is a type 2 diabetic, and certain ethnicities are more prone that others like Native Americans. Good luck!
