Perioperatives Risiko bei Adipositas

Zusammenfassung

Adipositas ist per se nicht mit einem erhöhten perioperativen Risiko verbunden. So haben Übergewichtige sowie moderat adipöse Patienten perioperativ ein niedrigeres Letalitätsrisiko verglichen mit normalgewichtigen Patienten. Demgegenüber zeigen untergewichtige Patienten mit einem BMI < 18,5 kg/m² eine erhöhte perioperative Sterblichkeit. Nach Risikoadjustierung für Begleiterkrankungen zeigen morbid Adipöse keine erhöhte perioperative Letalität. Dies wir auch unter dem Begriff “Adipositas-Paradoxon” subsumiert. Es verdeutlicht die Relevanz einer adäquaten perioperativen Behandlung vorliegender adipositasassoziierter Komorbiditäten für das perioperative Ergebnis.

Summary

Overweight and moderately obese patients undergoing non-bariatric surgery have paradoxically a lower risk compared to the normal weighted patients during the perioperative period. The highest mortality and morbidity rates are reported for underweight and morbidly obese patients. Obesity is a risk factor for hypertension, heart disease, and type-2 diabetes. Despite this finding in the perioperative setting overweight patients have a decreased risk of mortality. The better chance of survival when compared to normal-weight individuals in the perioperative setting has been called the obesity paradox.

Schlüsselwörter

Adipositas - Chirurgie - perioperatives Risiko - Sterblichkeit - Morbidität

Keywords

Obesity - surgery - perioperative risk - mortality - morbidity

• Literatur

• 1 Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med 2008; 36: 151-158.
• 2 Aldawood A, Arabi Y, Dabbagh O. Association of obesity with increased mortality in the critically ill patient. Anaesth Intensive Care 2006; 34: 629-633.
• 3 Allison DB, Saunders SE. Obesity in North America. An overview. Med Clin North Am 2000; 84: 305-332.
• 4 Berghöfer A, Pischon T, Reinhold T. et al. Obesity prevalence from a European perspective: a systematic review. BMC Public Health 2008; 08: 200.
• 5 Cahill Jr GF. Starvation in man. N Engl J Med 1970; 282: 668-675.
• 6 Catenacci VA, Hill JO, Wyatt HR. The obesity epidemic. Clin Chest Med 2009; 30: 415-444.
• 7 Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev 2009; 02: CD003641.
• 8 Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet 2003; 361: 2032-2035.
• 9 Eichenberger A, Proietti S, Wicky S. et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002; 95: 1788-1792.
• 10 Felbinger TW, Suchner U. Ernährungsstrategien bei kritisch kranken Patienten. Anästhesiologie & Intensivmedizin 2000; 41: 206-222.
• 11 Finkelstein EA, Brown DS, Wrage LA. et al. Individual and Aggregate Years-of-life-lost Associated With Overweight and Obesity. Obesity. 2009 online erschienen.
• 12 Gil A, Maria AC, Gil-Campos M, Canete R. Altered signalling and gene expression associated with the immune system and the inflammatory response in obesity. Br J Nutr 2007; 98 (Suppl. 01) S121-S126.
• 13 Gruberg L, Weissman NJ, Waksman R. et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?. J Am Coll Cardiol 2002; 39: 578-584.
• 14 Guh DP, Zhang W, Bansback N. et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 09: 88.
• 15 Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006; 444: 860-867.
• 16 Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004; 43: 1439-1444.
• 17 Marin JM, Carrizo SJ, Vicente E, Agusti AG. Longterm cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-1053.
• 18 Mullen JT, Moorman DW, Davenport DL. The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 2009; 250: 166-172.
• 19 National Health and Nutrition Examination Survey 2007–2008. Internetadresse: www.cdc.gov/nchs/nhanes.htm letzter Zugriff am 25.10.2009..
• 20 National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Intern Med 2000; 160: 898-904.
• 21 Nejat EJ, Polotsky AJ, Pal L. Predictors of chronic disease at midlife and beyond – the health risks of obesity. Maturitas. 2009 online erschienen.
• 22 Nguyen NT, Goldman C, Rosenquist CJ. et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001; 234: 279-289.
• 23 Obesity and overweight Fact sheet N°311 September. 2006 Internetadresse: www.who.int/mediacentre/factsheets/fs311/en/print.html letzter Zugriff am 27.10.2009.
• 24 Ogden CL, Carroll MD, Curtin LR. et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295: 1549-1555.
• 25 Oliveros H, Villamor E. Obesity and mortality in critically ill adults: a systematic review and metaanalysis. Obesity 2008; 16: 515-521.
• 26 Palma S, Cosano A, Mariscal M. et al. Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery. Br J Surg 2007; 94: 369-375.
• 27 Pasulka PS, Bistrian BR, Benotti PN, Blackburn GL. The risks of surgery in obese patients. Ann Intern Med 1986; 104: 540-546.
• 28 Picot J, Jones J, Colquitt JL. et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009; 13: 215-357.
• 29 Prem KA, Mensheha N, McKelvey JL. Operative treatment of adenocarcinoma of the endometrium in obese women. Am J Obstet Gynecol 1965; 92: 16-22.
• 30 Ray DE, Matchett SC, Baker K. et al. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005; 127: 2125-2131.
• 31 Schelbert KB. Comorbidities of obesity. Prim Care 2009; 36: 271-285.
• 32 Tanaka S, Inoue S, Isoda F. et al. Impaired immunity in obesity: suppressed but reversible lymphocyte responsiveness. Int J Obes Relat Metab Disord 1993; 17: 631-636.
• 33 Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest 2003; 123: 1202-1207.
• 34 Walter S, Kunst A, Mackenbach J. et al. Mortality and disability: the effect of overweight and obesity. Int J Obes. 2009 online erschienen.
• 35 Winkelman C, Maloney B, Kloos J. The impact of obesity on critical care resource use and outcomes. Crit Care Nurs Clin North Am 2009; 21: 403-422.
• 36 Yaggi HK, Concato J, Kernan WN. et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353: 2034-2041.
• 37 Zoremba M, Dette F, Hunecke T. et al. The influence of perioperative oxygen concentration on postoperative lung function in moderately obese adults. Eur J Anaesthesiol. 2009 online erschienen.