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Fast Track Gynaecologic Surgery in the Overweight and Obese Patient

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DOI: 10.4236/ijcm.2010.12011    4,987 Downloads   8,455 Views   Citations

ABSTRACT

Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un¬dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

J. Carter, S. Philp and V. Arora, "Fast Track Gynaecologic Surgery in the Overweight and Obese Patient," International Journal of Clinical Medicine, Vol. 1 No. 2, 2010, pp. 64-69. doi: 10.4236/ijcm.2010.12011.

References

[1] Commonwealth of Australia, “Australia: The Healthiest Country by 2020,” Technical Report 1. Obesity in Australia: a need for urgent action, Vol. 4, July 2009, pp. 21-128.
[2] World Health Organisation, “Obesity and overweight,” Fact Sheet, No. 311, September 2006, pp. 1-3.
[3] B. Anderson, J. P. Connor, J. I. Andrews, C. S. Davis, R. E. Buller and J. I. Sorosky et al., “Obesity and prognosis in endometrial cancer,” Am J Obstet Gynecol,. Vol. 174, No. 4, April 1996, pp. 1171-1178.
[4] A. Pellegrino, M. Signorelli, R. Fruscio, A. Villa, A. Buda and P. Beretta, et al., “Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy in obese women with stage I endometrial cancer,” Arch Gynecol Obstet, Vol. 279, No. 5, May 2009, pp. 655-660.
[5] C. P. Delaney, M. Zutshi, A. J. Senagore, F.H. Remzi, J. Hammel and V. W. Fazio, “Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection,” Disease of Colon Rectum, Vol. 46, No. 7, July 2003, pp. 851-859.
[6] C. Eskicioglu, S. S. Forbes, M. A. Aarts, A. Okrainec and R. S. McLeod, “Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials,” Journal of Gastrointestional Surgery, Vol. 13, No. 12, December 2009, pp. 2321-2329.
[7] H. Kehlet, “Principles of fast track surgery. Multimodal perioperative therapy programme,” Chirurg, Vol. ;80, No. 8, August 2009, pp. 687-689.
[8] H. Kehlet and D. W, “Wilmore Evidence-based surgical care and the evolution of fast-track surgery,” Annals Surgery, Vol. 248, No. 2, August 2008, pp. 189-98.
[9] D. Wilmore and H. Kehlet, “Recent advances. Management of patients in fast track surgery,” British Medical Journal, Vol. 322, 2001, pp. 473-476.
[10] N. Chopin, J. M. Malaret, M. C. Lafay-Pillet, A. Fotso, H. Foulot, C. Chapron, “Total laparoscopic hysterectomy for benign uterine pathologies: obesity does not increase the risk of complications,” Human Reproduction, Vol. 24, No. 12, December 2009, pp. 3057-3062.
[11] J. G. McDonnell, B. O. Donnell, G. Curley, A. Heffernan, C. Power and J, G. Laffey, “The Analgesic Efficacy of Transversus Abdominis Plane Block After Abdominal Surgery: A Prospective Randomized Controlled Trial,” Anesthesia and Analgesia, Vol. 104, No. 1, January 2007, pp. 193-197.
[12] A. L. Tan and S. Mohiuddin, “Obesity and surgery in gynaecology oncology,” Oil & Gas Magazine, Vol. 10, No. 4, December 2008, pp. 32-33.
[13] J. L. Parlow, R. Ahn and B. Milne, “Obesity is a risk factor for failure of ‘fast track’ extubation following coronary artery bypass surgery,” Canadian Journal of Anaesthesia, Vol. 53, No. 3, March 2006, pp. 288-294.
[14] C. I. Alexander and W.Liston, “Operating on the obese woman-a review,” An international journal of Obstetrics and Gynaecology, Vol. 113, No. 10, September.2006, pp. 1167-1172.
[15] J. Davidson, M. Kruse, D. Cox and R. Duncan, “Critical care of the morbidly obese,” Critical Care Nursing Quarterly, Vol. 26, No. 2, 2003, pp. 105-116.
[16] S. Gallager and J. Gates, “Obesity, Panniculitis, Panniculectomy, and Wound Care: Understanding the challenges. Journal of Wound,” Ostomy and Continence Nursing, Vol. 30, No. 6, 2003, pp. 334-341.
[17] N. Baugh, H. Zuelzer, J. Meador and J. Blankenship, “Wounds in surgical patients who are obese,” The American Journal Nursing, Vol. 106, No. 6, 2007, pp. 40-50.
[18] J. Carter, R. Szabo, W. Sim, S. Pather S. Philp and Nattress K, et al., “Fast Track Surgery in Gynaecological Oncology. A Clinical Audit,” Australia and NewZealand Journal Obstet and Gynaecoogyl, Vol. 50, 2010, pp. 159-163.
[19] S. Kondalsamy-Chennakesavan, C. Bouman, S. De Jong, K. Sanday, J. Nicklin and R. Land, et al., “Clinical audit in gynecological cancer surgery: development of a risk scoring system to predict adverse events,” Gynecologic Oncology, Vol. 115, No. 3, December 2009, pp. 329-333.
[20] M. Frumovitz, C. C. Sun, A. Jhingran, K. M. Schmeler, R. Dos Reis, M. R. Milam, et al., “Radical hysterectomy in obese and morbidly obese women with cervical cancer,” Obstet Gynecol, Vol. 112, No. 4, October 2008, pp. 899-905.

  
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