Comparison of Intensive Care Unit Outcomes Between Obese and Non-Obese Postmenopausal Women Undergoing Gastric Surgeryy

Seyed Hoseini, Seyed Vahid; Rezaei, Mansour

doi:10.5281/zenodo.21433129

Comparison of Intensive Care Unit Outcomes Between Obese and Non-Obese Postmenopausal Women Undergoing Gastric Surgeryy

Document Type : Original Article

Authors

Seyed Vahid Seyed Hoseini ¹

Mansour Rezaei ²

¹ Assistant Professor of Surgery, Department of General Surgery, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

² Associate Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz, Iran.

https://doi.org/10.5281/zenodo.21433129

Abstract

Introduction: This study compares intensive care unit outcomes between obese and non-obese postmenopausal women undergoing gastric surgery, a population vulnerable to distinct metabolic and respiratory risks. Ultimately, we aim to evaluate how obesity status influences postoperative ICU length of stay, complication rates, and resource utilization in these patients.

Material and methods: This descriptive cross-sectional study was conducted at Tabriz University of Medical Sciences during 2023 and included 215 postmenopausal women selected through convenience sampling. Sample size was estimated using the Cochran formula for a single-population proportion. The study assessed demographic, clinical, surgical, and ICU-related variables, including obesity status, comorbidities, operative characteristics, inflammatory markers, postoperative complications, and key intensive care outcomes.

Results: Obese postmenopausal women experienced significantly longer ICU stays (54.82 ± 14.63 vs. 38.15 ± 9.47 hours; p < 0.001) and prolonged mechanical ventilation (8.42 vs. 4.15 hours). Higher rates of respiratory distress (29.81% vs. 9.91%; p < 0.001) and wound infections (12.50% vs. 3.60%; p = 0.014) were observed. Consequently, obesity extended total hospitalization to 8.74 days compared to 6.82 days (p < 0.001), reflecting a more complex and resource-intensive postoperative recovery trajectory.

Conclusion: Obesity in postmenopausal women significantly impairs recovery after gastric surgery, leading to extended ICU stays and increased respiratory and infectious complications. These findings suggest that obese patients require more intensive perioperative management and specialized monitoring. Clinicians should prioritize early mobilization and targeted pulmonary interventions to mitigate the heightened resource utilization and clinical risks associated with elevated body mass in this population.

Graphical Abstract

Comparison of Intensive Care Unit Outcomes Between Obese and Non-Obese Postmenopausal Women Undergoing Gastric Surgeryy

Keywords

Obesity

Gastric Surgery

Postmenopausal Women

ICU Outcomes

Subjects

Cancer

[1] Blüher, M. (2020). Metabolically healthy obesity. Endocrine Reviews, *41*(3), bnaa004.

[2] GBD 2021 Adult BMI Collaborators. (2025). Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021. The Lancet, *405*(10485), 813-838.

[3] Mauvais-Jarvis, F. (2015). Sex differences in metabolic homeostasis, diabetes, and obesity. Biology of Sex Differences, *6*, 14.

[4] Karpe, F., & Pinnick, K. E. (2015). Biology of upper-body and lower-body adipose tissue—Link to whole-body phenotypes. Nature Reviews Endocrinology, *11*, 90-100.

[5] Kaikaew, K., Grefhorst, A., & Visser, J. A. (2021). Sex differences in brown adipose tissue function: Sex hormones, glucocorticoids, and their crosstalk. Frontiers in Endocrinology (Lausanne), *12*, 652444.

[6] Witkam, R., Gwinnutt, J. M., Humphreys, J., Gandrup, J., Cooper, R., & Verstappen, S. M. M. (2021). Do associations between education and obesity vary depending on the measure of obesity used? A systematic literature review and meta-analysis. SSM - Population Health, *15*, 100884.

[7] Kanter, R., & Caballero, B. (2012). Global gender disparities in obesity: A review. Advances in Nutrition, *3*(4), 491-498.

[8] Manolopoulos, K. N., Karpe, F., & Frayn, K. N. (2010). Iliofemoral body fat as a determinant of metabolic health. International Journal of Obesity, *34*, 949-959.

[9] Martínez-Cignoni, M. R., González-Vicens, A., Morán-Costoya, A., Proenza, A. M., Gianotti, M., Valle, A., & Llado, I. (2021). Estrogen impairs adipose tissue expansion and cardiometabolic profile in obese-diabetic female rats. International Journal of Molecular Sciences, *22*(24), 13573.

[10] Palmer, B. F., & Clegg, D. J. (2015). The sexual dimorphism of obesity. Molecular and Cellular Endocrinology, *402*, 113-119.

[11] Mittal, B. (2019). Subcutaneous adipose tissue & visceral adipose tissue. Indian Journal of Medical Research, *149*(5), 571-573.

[12] Bardhi, O., Palmer, B. F., & Clegg, D. J. (2023). The evolutionary impact and influence of oestrogens on adipose tissue structure and function. Philosophical Transactions of the Royal Society B: Biological Sciences, *378*(1881), 20220207.

[13] Ley, C. J., Lees, B., & Stevenson, J. C. (1992). Sex- and menopause-associated changes in body-fat distribution. The American Journal of Clinical Nutrition, *55*(5), 950-954.

[14] Svendsen, O. L., Hassager, C., & Christiansen, C. (1995). Age- and menopause-associated variations in body composition and fat distribution in healthy women as measured by dual-energy X-ray absorptiometry. Metabolism, *44*(3), 369-373.

[15] Abildgaard, J., Danielsen, E. R., Dorph, E., Thomsen, C., Juul, A., Ewertsen, C., & Pedersen, B. K. (2018). Ectopic lipid deposition is associated with insulin resistance in postmenopausal women. Journal of Clinical Endocrinology & Metabolism, *103*(9), 3394-3404.

[16] Jeffery, E., Wing, A., Holtrup, B., Sebo, Z., Kaplan, J. L., Saavedra-Peña, R., ... & Rodeheffer, M. S. (2016). The adipose tissue microenvironment regulates depot-specific adipogenesis in obesity. Cell Metabolism, *24*(1), 142-150.

[17] Zhu, J., Zhang, L., Ji, M., Jin, B., & Shu, J. (2023). Elevated adipose differentiation-related protein level in ovariectomized mice correlates with tissue-specific regulation of estrogen. Journal of Obstetrics and Gynaecology Research, *49*(4), 1173-1179.

[18] Anderson, L. A., McTernan, P. G., Barnett, A. H., & Kumar, S. (2001). The effects of androgens and estrogens on preadipocyte proliferation in human adipose tissue: Influence of gender and site. Journal of Clinical Endocrinology & Metabolism, *86*(10), 5045-5051.

[19] Mohammadi, K. , Separham, A. and Salehi Vala, S. (2026). Correlation Between Modified Shock Index and Number/Type of Involved Vessels in STEMI Patients: A Predictive Approach. Medicinal, Psychological, and Health Research Journal (mphrj), 2(1), 26-34.

[20] Gavin, K. M., Cooper, E. E., & Hickner, R. C. (2013). Estrogen receptor protein content is different in abdominal than gluteal subcutaneous adipose tissue of overweight-to-obese premenopausal women. Metabolism, *62*(8), 1180-1188.

[21] Davis, K. E., Neinast, M. D., Sun, K., Skiles, W. M., Bills, J. D., Zehr, J. A., ... & Clegg, D. J. (2013). The sexually dimorphic role of adipose and adipocyte estrogen receptors in modulating adipose tissue expansion, inflammation, and fibrosis. Molecular Metabolism, *2*(3), 227-242.

[22] Yepuru, M., Eswaraka, J., Kearbey, J. D., Barrett, C. M., Raghow, S., Veverka, K. A., ... & Dalton, J. T. (2010). Estrogen receptor-β-selective ligands alleviate high-fat diet- and ovariectomy-induced obesity in mice. Journal of Biological Chemistry, *285*(41), 31292-31303.

[23] Pedersen, S. B., Kristensen, K., Hermann, P. A., Katzenellenbogen, J. A., & Richelsen, B. (2004). Estrogen controls lipolysis by up-regulating alpha2A-adrenergic receptors directly in human adipose tissue through the estrogen receptor alpha: Implications for the female fat distribution. Journal of Clinical Endocrinology & Metabolism, *89*(4), 1869-1878.

[24] Taylor, R. W., Grant, A. M., Williams, S. M., & Goulding, A. (2010). Sex differences in regional body fat distribution from pre- to post-puberty. Obesity, *18*(7), 1410-1416.

[25] He, Q., Horlick, M., Thornton, J., Wang, J., Pierson, R. N., Jr., Heshka, S., & Gallagher, D. (2002). Sex and race differences in fat distribution among Asian, African-American, and Caucasian prepubertal children. Journal of Clinical Endocrinology & Metabolism, *87*(5), 2164-2170.

[26] Chen, X., McClusky, R., Chen, J., Beaven, S. W., Tontonoz, P., Arnold, A. P., & Reue, K. (2012). The number of X chromosomes causes sex differences in adiposity in mice. PLoS Genetics, *8*(5), e1002709.

[27] Bardsley, M. Z., Kowal, K., Levy, C., Gosek, A., Ayari, N., Tartaglia, N., ... & Ross, J. L. (2013). 47, XYY syndrome: Clinical phenotype and timing of ascertainment. Journal of Pediatrics, *163*(4), 1085-1094.

[28] Sadeghi Joni, S., Gerami, R., Akhondi, N., Etemadi, A., Fosouli, M., & Eghbal, A. F. (2022). Investigating the role of susceptibility weighted imaging for assessment of ischemic penumbra with respect to Venus's blood flow in ischemic stroke patients. International Journal of Physiology, Pathophysiology and Pharmacology, *14*(3), 200-205.