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Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine

Obesity is associated with long-term morbidity and mortality, but it is unclear if obesity affects goals of care determination and intensive care unit (ICU) resource utilization during hospitalization under a general medicine service. In a cohort of 5113 adult patients admitted under general medicin...

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Autores principales: Lim, Andy K. H., Rathnasekara, Greasha K., Kanumuri, Priyanka, Malawaraarachchi, Janith K., Song, Zheng, Curtis, Claire A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9786344/
https://www.ncbi.nlm.nih.gov/pubmed/36555885
http://dx.doi.org/10.3390/jcm11247267
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author Lim, Andy K. H.
Rathnasekara, Greasha K.
Kanumuri, Priyanka
Malawaraarachchi, Janith K.
Song, Zheng
Curtis, Claire A.
author_facet Lim, Andy K. H.
Rathnasekara, Greasha K.
Kanumuri, Priyanka
Malawaraarachchi, Janith K.
Song, Zheng
Curtis, Claire A.
author_sort Lim, Andy K. H.
collection PubMed
description Obesity is associated with long-term morbidity and mortality, but it is unclear if obesity affects goals of care determination and intensive care unit (ICU) resource utilization during hospitalization under a general medicine service. In a cohort of 5113 adult patients admitted under general medicine, 15.3% were obese. Patients with obesity were younger and had a different comorbidity profile than patients who were not obese. In age-adjusted regression analysis, the distribution of goals of care categories for patients with obesity was not different to patients who were not obese (odds ratio for a lower category with more limitations, 0.94; 95% confidence interval [CI]: 0.79–1.12). Patients with obesity were more likely to be directly admitted to ICU from the Emergency Department, require more ICU admissions, and stayed longer in ICU once admitted. Hypercapnic respiratory failure and heart failure were more common in patients with obesity, but they were less likely to receive mechanical ventilation in favor of non-invasive ventilation. The COVID-19 pandemic was associated with 16% higher odds of receiving a lower goals of care category, which was independent of obesity. Overall hospital length of stay was not affected by obesity. Patients with obesity had a crude mortality of 3.8 per 1000 bed-days, and age-adjusted mortality rate ratio of 0.75 (95% CI: 0.49–1.14) compared to patients who were not obese. In conclusion, there was no evidence to suggest biased goals of care determination in patients with obesity despite greater ICU resource utilization.
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spelling pubmed-97863442022-12-24 Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine Lim, Andy K. H. Rathnasekara, Greasha K. Kanumuri, Priyanka Malawaraarachchi, Janith K. Song, Zheng Curtis, Claire A. J Clin Med Article Obesity is associated with long-term morbidity and mortality, but it is unclear if obesity affects goals of care determination and intensive care unit (ICU) resource utilization during hospitalization under a general medicine service. In a cohort of 5113 adult patients admitted under general medicine, 15.3% were obese. Patients with obesity were younger and had a different comorbidity profile than patients who were not obese. In age-adjusted regression analysis, the distribution of goals of care categories for patients with obesity was not different to patients who were not obese (odds ratio for a lower category with more limitations, 0.94; 95% confidence interval [CI]: 0.79–1.12). Patients with obesity were more likely to be directly admitted to ICU from the Emergency Department, require more ICU admissions, and stayed longer in ICU once admitted. Hypercapnic respiratory failure and heart failure were more common in patients with obesity, but they were less likely to receive mechanical ventilation in favor of non-invasive ventilation. The COVID-19 pandemic was associated with 16% higher odds of receiving a lower goals of care category, which was independent of obesity. Overall hospital length of stay was not affected by obesity. Patients with obesity had a crude mortality of 3.8 per 1000 bed-days, and age-adjusted mortality rate ratio of 0.75 (95% CI: 0.49–1.14) compared to patients who were not obese. In conclusion, there was no evidence to suggest biased goals of care determination in patients with obesity despite greater ICU resource utilization. MDPI 2022-12-07 /pmc/articles/PMC9786344/ /pubmed/36555885 http://dx.doi.org/10.3390/jcm11247267 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lim, Andy K. H.
Rathnasekara, Greasha K.
Kanumuri, Priyanka
Malawaraarachchi, Janith K.
Song, Zheng
Curtis, Claire A.
Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine
title Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine
title_full Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine
title_fullStr Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine
title_full_unstemmed Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine
title_short Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine
title_sort goals of care, critical care utilization and clinical outcomes in obese patients admitted under general medicine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9786344/
https://www.ncbi.nlm.nih.gov/pubmed/36555885
http://dx.doi.org/10.3390/jcm11247267
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