Patients with class II and III obesity and end-stage renal disease are often ineligible for kidney transplantation (KTx) due to increased postoperative complications and technically challenging surgery. Bariatric surgery (BS) can be an effective solution for KTx candidates who are considered inoperable. The aim of this study is to evaluate outcomes of KTx after BS and to compare the outcomes to obese recipients (BMI ≥ 35 kg/m ) without BS. This retrospective, single-center study included patients who received KTx after BS between January 1994 and December 2018. The primary outcome was postoperative complications. The secondary outcomes were graft and patient survival. In total, 156 patients were included, of whom 23 underwent BS prior to KTx. There were no significant differences in postoperative complications. After a median follow-up of 5.1 years, death-censored graft survival, uncensored graft survival, and patient survival were similar to controls (log rank test p = .845, .659, and .704, respectively). Dialysis pre-transplantation (Hazard Ratio (HR) 2.55; 95%CI 1.03-6.34, p = .043) and diabetes (HR 2.41; 95%CI 1.11-5.22, p = .027) were independent risk factors for all-cause mortality. A kidney from a deceased donor was an independent risk factor for death-censored graft loss (HR 1.98; 95%CI 1.04-3.79, p = .038). Patients who received a KTx after BS have similar outcomes as obese transplant recipients.
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http://dx.doi.org/10.1111/ctr.14208 | DOI Listing |
Gynecol Oncol
January 2025
Division of Gynecologic Oncology, St. Luke's University Health Network, Bethlehem, PA, United States of America.
Objective: We sought to determine the cost-effectiveness (CE) of lymph node dissection (LND) at the time of hysterectomy for endometrial intraepithelial neoplasia (EIN).
Methods: A decision analytic model was created to evaluate the strategies of routine full LND, sentinel lymph node dissection (SNLD), SNLD without advancing to full LND in the event of non-mapping, and full LND based on Mayo Criteria, versus no LND. Patients in the no LND group and those in the SLND group without advancement to full LND in the event of non-mapping who were found to have EC on final pathology and suspicious post-operative imaging underwent full LND.
Best Pract Res Clin Anaesthesiol
March 2024
Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. Electronic address:
This review documents the importance of postoperative interventions that accelerate the functional recovery of the thoracic surgical patient. Enhanced recovery after surgery (ERAS) pathways aim to mitigate the harmful surgical stress response. Improvements to the entire patient pathway, by removing unnecessary care elements while introducing evidence-based interventions, have synergistic effects.
View Article and Find Full Text PDFBest Pract Res Clin Anaesthesiol
March 2024
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Department of Anesthesia and Critical Care Medicine, 1275 York Avenue, New York, NY, 10028, USA. Electronic address:
The objectives of this minireview are two-fold. The first is to discuss the evolution of opioid analgesia in perioperative medicine in the context of thoracic non-cardiac surgery. Current standard-of-care, aiming to optimize analgesia and limit undesirable side effects, is discussed in the context of multimodal analgesia, specifically enhanced recovery after thoracic surgery pathways.
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March 2024
Department of Anesthesiology, Columbia University, 622 W 168th St, New York, 10032, NY, United States. Electronic address:
Effective pain control is crucial in the management of thoracic surgical patients since it reduces postoperative morbidity and promotes recovery. These patients have co-existing respiratory diseases and impaired pulmonary function, which may be further impaired by surgery. With the adoption of minimally invasive surgical techniques and an emphasis on enhancing recovery after surgery, multimodal analgesia has gained popularity as a way to reduce perioperative opioid use and its associated adverse events such as respiratory depression.
View Article and Find Full Text PDFAfr J Reprod Health
December 2024
Department of Cardiology, The First Affiliated Hospital,Hengyang Medical School, University of South China.
Anaemia is a common phenomenon in patients with malignant gynecological tumors. The occurrence of anaemia in the perioperative period leads to an increased probability of blood transfusion, increased surgical complications,poor wound healing, prolonged hospitalization, increased medical costs, and increased mortality. Intravenous iron, which is known for its rapid onset and lack of gastrointestinal side effects, has become increasingly prevalent in clinical practice.
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