Impact of Body Mass Index on Outcomes in Cardiac Surgery

Mei Gao, Jianzhong Sun, J Nilas Young, Walter D Boyd, Zane Atkins, Zhongmin Li, Qian Ding, James Diehl, Hong Liu

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: Body mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery. Design: A retrospective cohort study. Setting: University teaching hospital, 2 centers. Participants: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from July 1, 2001, to June 30, 2013, in 1 hospital and from September 1, 2003, to August 31, 2014, in a second hospital. Interventions: No changes to standard practice were required. Measurements and Main Results: Patients were assigned into 6 BMI groups as follows: underweight (BMI<18.5 kg/m2), normal weight (≥18.5 to<25 kg/m2), overweight (≥25 to<30 kg/m2), class I obese (≥30 to<35 kg/m2), class II obese (≥35 to<40 kg/m2), and class III obese (BMI≥40 kg/m2). Short-term major postoperative complications (postoperative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, intensive care unit readmission, total intensive care unit hours, and readmission in 30 days, and mortalities (in-hospital mortality, 30-day mortality, surgical mortality) were compared among various BMI groups after cardiac surgery. Age, sex, surgery type, family history of coronary artery disease, diabetes, hypertension, heart failure, and lipid-lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that the underweight and class III obese BMI groups demonstrated significant, adverse differences in some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter, and renal failure. However, being in the overweight or class I obese group demonstrated a positive effect on discharge and surgical mortality. Conclusions: The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an "obese paradox" in short-term mortality after cardiac surgery.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Thoracic Surgery
Body Mass Index
Thinness
Mortality
Atrial Flutter
Obesity
Atrial Fibrillation
Renal Insufficiency
Intensive Care Units
Ventilation
Hospital Mortality
Infection
Heart Arrest
Teaching Hospitals
Renal Dialysis
Coronary Artery Disease
Sepsis
Pneumonia
Cohort Studies
Cardiovascular Diseases

Keywords

  • Body mass index
  • Cardiac surgery
  • Mortality
  • Obese
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Impact of Body Mass Index on Outcomes in Cardiac Surgery. / Gao, Mei; Sun, Jianzhong; Young, J Nilas; Boyd, Walter D; Atkins, Zane; Li, Zhongmin; Ding, Qian; Diehl, James; Liu, Hong.

In: Journal of Cardiothoracic and Vascular Anesthesia, 2016.

Research output: Contribution to journalArticle

Gao, Mei ; Sun, Jianzhong ; Young, J Nilas ; Boyd, Walter D ; Atkins, Zane ; Li, Zhongmin ; Ding, Qian ; Diehl, James ; Liu, Hong. / Impact of Body Mass Index on Outcomes in Cardiac Surgery. In: Journal of Cardiothoracic and Vascular Anesthesia. 2016.
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AU - Gao, Mei

AU - Sun, Jianzhong

AU - Young, J Nilas

AU - Boyd, Walter D

AU - Atkins, Zane

AU - Li, Zhongmin

AU - Ding, Qian

AU - Diehl, James

AU - Liu, Hong

PY - 2016

Y1 - 2016

N2 - Objectives: Body mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery. Design: A retrospective cohort study. Setting: University teaching hospital, 2 centers. Participants: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from July 1, 2001, to June 30, 2013, in 1 hospital and from September 1, 2003, to August 31, 2014, in a second hospital. Interventions: No changes to standard practice were required. Measurements and Main Results: Patients were assigned into 6 BMI groups as follows: underweight (BMI<18.5 kg/m2), normal weight (≥18.5 to<25 kg/m2), overweight (≥25 to<30 kg/m2), class I obese (≥30 to<35 kg/m2), class II obese (≥35 to<40 kg/m2), and class III obese (BMI≥40 kg/m2). Short-term major postoperative complications (postoperative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, intensive care unit readmission, total intensive care unit hours, and readmission in 30 days, and mortalities (in-hospital mortality, 30-day mortality, surgical mortality) were compared among various BMI groups after cardiac surgery. Age, sex, surgery type, family history of coronary artery disease, diabetes, hypertension, heart failure, and lipid-lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that the underweight and class III obese BMI groups demonstrated significant, adverse differences in some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter, and renal failure. However, being in the overweight or class I obese group demonstrated a positive effect on discharge and surgical mortality. Conclusions: The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an "obese paradox" in short-term mortality after cardiac surgery.

AB - Objectives: Body mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery. Design: A retrospective cohort study. Setting: University teaching hospital, 2 centers. Participants: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from July 1, 2001, to June 30, 2013, in 1 hospital and from September 1, 2003, to August 31, 2014, in a second hospital. Interventions: No changes to standard practice were required. Measurements and Main Results: Patients were assigned into 6 BMI groups as follows: underweight (BMI<18.5 kg/m2), normal weight (≥18.5 to<25 kg/m2), overweight (≥25 to<30 kg/m2), class I obese (≥30 to<35 kg/m2), class II obese (≥35 to<40 kg/m2), and class III obese (BMI≥40 kg/m2). Short-term major postoperative complications (postoperative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, intensive care unit readmission, total intensive care unit hours, and readmission in 30 days, and mortalities (in-hospital mortality, 30-day mortality, surgical mortality) were compared among various BMI groups after cardiac surgery. Age, sex, surgery type, family history of coronary artery disease, diabetes, hypertension, heart failure, and lipid-lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that the underweight and class III obese BMI groups demonstrated significant, adverse differences in some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter, and renal failure. However, being in the overweight or class I obese group demonstrated a positive effect on discharge and surgical mortality. Conclusions: The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an "obese paradox" in short-term mortality after cardiac surgery.

KW - Body mass index

KW - Cardiac surgery

KW - Mortality

KW - Obese

KW - Outcome

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