Underweight People at Higher Risk after Surgery

People who are underweight, or have a low BMI,  have a 40 percent higher risk of dying in the first month after surgery than patients who are overweight, according to new research.

CHICAGO (Reuters) - People who are underweight have a 40 percent higher risk of dying in the first month after surgery than patients who are overweight, according to new research released on Monday.

The findings suggest that body mass index, or BMI, may be useful in predicting which patients are at the greatest risk while recovering from surgery, U.S. researchers reported in the Archives of Surgery.

Prior studies looking at the role of BMI in surgery have been mixed, said George Stukenborg of the University of Virginia in Charlottesville, who worked on the study.

"Patients with low BMI are at higher risk of death 30 days after surgery," Stukenborg said in a telephone interview.

The researchers used data on nearly 190,000 patients who underwent a variety of surgeries at 183 hospitals between 2005 and 2006.

BMI is calculated by dividing weight in kilograms by height in meters squared. According to the U.S. Centers for Disease Control and Prevention, people with a BMI of 18.5 to 24.9 are normal weight, those with a BMI of 25 to 29.9 are overweight, and those with a BMI of 30 and above are obese.

To look for a link between body weight and the risk of death, the researchers classified patients into five groups or quintiles: people with a BMI of less than 23.1; people with a BMI of 23.1 to less than 26.3; people with a BMI of 26.3 to less than 29.7; people with a BMI of 29.7 to less than 35.3; and people with a BMI of 35.3 or higher.

Overall, 2,245 or 1.7 percent of people in the study died within 30 days of surgery.

"We found patients in the lowest quintile had 40 percent higher odds of death compared to the mid-range," said Stukenborg, referring to people in the overweight category with BMIs of 26.3 to 29.7.

Even when the researchers adjusted for type of surgery and other risk factors, those with a low BMI still had a greater risk of dying in the first month after surgery compared with plumper surgery patients.

Stukenborg said it is not clear why. The study did not track recent weight loss, so it could be that people who weighed less were sicker to begin with.

"That is a possibility," he said.

Either way, Stukenborg said doctors should consider BMI when they plan surgeries for their patients.

Being overweight or obese carries many other risk, raising chances of heart disease, diabetes, some cancers, arthritis and other conditions. Obesity-related diseases account for nearly 10 percent of medical spending in the United States or an estimated $147 billion a year.

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Stabilization in Number of AIDS Cases Marks Decline in Global Epidemic

The number of new cases of AIDS is leveling off with the number of people infected with the HIV virus having remained unchanged since 2007.

The number of new cases of AIDS is leveling off with the number of people infected with the HIV virus having remained unchanged since 2007. The information comes from a new report recently released by the United Nations.

According to the joint United Nations program on HIV and AIDS (UNAIDS), the number of new HIV infections appears to have stabilized with approximately 2.7 million occurring last year, which is about the same number of cases reported in the three years prior. The latest numbers serve as confirmation of findings released by UNAIDS earlier this year.

In 2010, the number of AIDS-related deaths reported was 1.8 million, reflecting a decline from 1.9 million deaths in 2009. 

About 34 million people were living with the AIDS-causing HIV virus by the end of last year. Although this is actually a slight increase from prior years, this is likely due to an increased survival rate among those having the illness.

But the threat of AIDS has by no means been diminished, having no method for preventing the deadly disease that has no cure. 

Although the decline in the number of cases of HIV reflects a positive trend, millions who suffer from the disease continue to go untreated and reportedly, donations have declined amidst a struggling economy.

While for North America and Western Europe, the continued outbreak “remains stubbornly steady,” according to U.N. report, southern Africa continues to suffer the worst. Although the peak of infection occurred in 1997, following a drop of more than 26 percent in the number of new infections, Sub-Saharan Africa still accounted for 70 percent of the world’s new infections last year.

In addition, the number of new infections of HIV has soared by 250 percent in Eastern Europe and central Asia over the last decade, mainly due shared needles among drug addicts.

The strategic goal of UNAIDS is to achieve a rate of zero new HIV infections and AIDS-related deaths, as well as zero discrimination. Critics say that while the goals are admirable, these goals are unattainable. They point out that total elimination of the disease is highly unlikely.

UNAIDS deputy executive director Dr. Paul De Lay, said that he recognized the goal of elimination of infection as “more of a vision for the future,” pointing out that success would require a method of prevention, such as a vaccine, and that the development of such an effective tool could take decades.

For now, De Lay noted that the U.N. will aim their efforts at more aggressive prevention and treatment, including earlier intervention for those infected with HIV. In the future, the group may focus on providing medication to uninfected individuals at high risk for the virus.

The World Health Organization is currently considering ways to counsel countries in the midst of major epidemics regarding methods of prevention, including the provision of drugs to such high-risk people as injection drug addicts, gay men, and prostitutes. However, giving AIDS drugs to healthy people has its downside. Those who take these medications can suffer serious side effects, and the use of the drugs may also promote drug resistance.

Meanwhile, for those already infected, the report said that low and middle income countries have been experiencing a surge in the number of people getting access to antiretroviral therapy since 2009, and that these treatments are significantly impacting the rate of new infections. The leveling off of new cases of HIV is a positive move forward, and UNAIDS remains optimistic in working toward further diminishment of the AIDS-causing virus.

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The World of Post-Mastectomy

In the struggle to overcome breast cancer, many women lose a valuable part of themselves to mastectomies, but breast reconstruction is a viable option for many.

In the struggle to overcome breast cancer, many women lose a valuable part of themselves to mastectomies. Thanks to breast reconstruction surgery, however, the change is neither permanent nor noticeable. For women who aspire to be complete again after the fight of their lives, it helps to learn about the procedure of breast reconstruction, how to find a plastic surgeon, and why other women are making the choice. 

For the 56 percent of American breast cancer patients that received mastectomies, more than 76 percent had a number of plausible reasons to pursue the procedure. One patient featured on breastcancer.org struck a couple of major notes that echo throughout the post-mastectomy world of women:

In addition to fashion and forgetting, breast reconstruction surgery improves confidence, physical appeal, and even balance in women.

Upon making the decision to proceed with breast reconstruction surgery, the exact kind of procedures available varies on a number of determinants such as the extent of the mastectomy, patient preference, age, and other factors. The two general options involved with the surgery are implants and tissue flaps. 

Offering permanence and a more realistic feel over their prosthetic counterparts, breast implants are silicone cups filled with fluid. More often than not, this fluid is a saline solution. For mastectomy patients who are eligible for immediate reconstruction, silicone breast implants may be added in the same session as the mastectomy. This is as simple as inserting the implant correctly after the breast has been removed.

Two-stage or delayed reconstruction is performed in the event that the patient does not have enough surrounding tissue to support silicone breast implants immediately following the mastectomy. Surgeons preparing a patient for delayed reconstruction will insert an expander under the chest tissues. They will then regularly expand the device by adding fluid, eventually reaching the needed capacity for an implant. 

As it concerns tissue flap procedures, the main premise remains the same throughout: expendable tissues from other areas of the body that meet certain specifications are used to reconstruct lost breast tissue.

Two of the most common of these procedures are the Transverse Rectus Abdominus Flap and the Latissimus Dorsi Flap.

Transverse Rectus Abdominus Flaps use muscular tissue and skin from the lower abdomen to reconstruct breasts. There are two different kinds of Transverse Rectus Abdominus Flaps: Pedicle flap and Free flap. A Pedicle flap is moved to the breast under the skin, staying connected to its blood supply. A Free flap is complete extraction of tissue and placement at the breast, requiring reattachment of veins and arteries.

The Latissimus Dorsi or “lat” muscle of the middle and upper back can provide the necessary tissue to aid in breast reconstruction. In this procedure the tissue is transported to the chest cavity under the skin.

When searching for a plastic surgeon, the best way to honestly get to know their accreditations and experience is through reputable organizations that refer and recommend them. The ASPS or American Society of Plastic Surgeons, for example, offers a database teeming with board certified plastic surgeons. The society’s resources detail the qualifications, specialities, and services of all of their members.

Aside from associations and referrals, old-fashioned word of mouth is another vein of research that minimizes bias. Finding more than one testimonial of a particular surgeon’s work, however, when narrowing options, is highly recommended. Finally, assessing board certified plastic surgeons through personal interviews will illuminate past history of work, experience, and education.

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