Influence of obesity on in-hospital and early mortality and morbidity after myocardial revascularization

Abstract

Objective: Obese patients are thought to have an increased risk for complications in coronary artery bypass surgery. Several risk stratification systems do not identify obesity as a variable for risk adjustment. The aim of this study is to evaluate the in-hospital and early (one year) mortality and morbidity in obese and non-obese patients after a CABG in the UMC St Radboud. Methods: The data of 1130 patients undergoing a myocardial revascularization from January 2000 to August 2002 were analyzed. Obesity was measured by the body mass index (BMI). A BMI $ 30 kg/m 2 was defined as obese. We compared 206 obese patients with 924 non-obese patients. Uni-and multivariate analysis were used to analyze the results. The 1-year survival was analyzed using Kaplan -Meier methods. Results: There were no significant differences between obese and non-obese patients according to postoperative myocardial infarction, re-operation for bleeding, in-hospital mortality, renal complications, neurological complications, pulmonary complications, gastrointestinal complications, re-intubation, re-admission on intensive care, ventilation time, days on intensive care, days in hospital and late mortality. Only the incidence of postoperative wound infections was increased in obese patients, 8.3% in the obese versus 4.4% in the non-obese ðP ¼ 0:02Þ: Multivariate analysis identified obesity only as risk factor for postoperative for wound infections (P ¼ 0:04; odds ratio: 1.97). Conclusions: Obese patients do not have an increased risk of in-hospital and early (1 year) mortality after CABG. However, obese patients have an increased risk of postoperative wound infections compared to non-obese patients. q

Isolated Coronary Artery Bypass Grafting in Obese Individuals - A Propensity Matched Analysis of Outcomes -

“…Some studies found a higher incidence of mortality in the postoperative and mid-term follow-up after CABG in obese patients, 14-17 whereas others did not find this association. [20][21][22][23][24][25][26][27][28][29][30][31] There are reports of increased operative mortality in morbidly obese individuals. 18, 19 In a recent systematic review, Oreopoulos et al reported a lower mortality in obese patients undergoing CABG.…”

“…13 Although some authors have reported higher postoperative and mid-term mortality in obese 14-17 and morbidly obese 18, 19 patients after CABG, others have failed to confirm this association. [20][21][22][23][24][25][26][27][28][29][30][31] Obesity is considered as a predictor for post-cardiac surgery 30-day mortality in a risk stratification system devised by Parsonnet et al 10 Although several studies have demonstrated an increased cardiovascular risk in obese individuals, there is an increasing body of literature describing the obesity paradox, suggesting possible protection from adverse cardiovascular events in obese patients, including congestive heart failure (CHF). 6,32-37 Some of these studies also suffer Outcome After Isolated CABG in Obese Individuals from selection bias since obese patients, on average, have a higher number of associated comorbidities, and the use of logistic regression analysis may not completely adjust for this selection bias.…”

Impact of neurohormonal blockade on association between body mass index and mortality

“…In patients undergoing coronary by-pass surgery, those with low BMI were at higher risk for adverse outcome, compared to obese patients [10]. In another study, obesity was not associated with increased in-hospital or 1-year mortality following coronary by-pass surgery [16]. In yet another study of patients after coronary by-pass surgery, those who were overweight or obese had significantly better survival free from major cardiac or cerebrovascular events, compared to those with normal BMI [15].…”

“…The results from prior studies on the prognostic importance of BMI in patients with established coronary artery disease and after acute myocardial infarction are inconsistent [3][4][5][6][7][8][9][10][11][12][13][14][15][16]19]. In a study in survivors of a first acute myocardial infarction, obesity was associated with increased risk of recurrent coronary events during 3 years of follow-up [3].…”

“…However, the prognostic importance of overweight and obesity in patients with coronary artery disease and following acute myocardial infarction is not yet fully understood. Studies have shown diverse and even contradictory results; high body mass index (BMI) has had a negative, neutral or even positive effect on survival [3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”