Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals

Shamszad, Pirouz; Rossano, Joseph W.; Marino, Bradley S.; Lowry, Adam W.; Knudson, Jarrod D.

doi:10.1111/chd.12325

Cited by 18 publications

(18 citation statements)

References 24 publications

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“…Shamszad and colleagues used data from the Pediatric Health Information Systems Database to perform a matched cohort study of obese and control subjects undergoing congenital heart surgery. This study failed to demonstrate a significant difference in mortality or other perioperative adverse outcomes 8 , but was notably limited by a small study population and no patient- or procedure-level risk stratification. In addition, classification of subject’s as obese or otherwise was dependent on billing codes, since height and weight data are not available in the data source.…”

Section: Discussionmentioning

confidence: 90%

“…It is not clear that these results can be extrapolated for younger patients with CHD, and data on the subject is limited. A single previous matched cohort study attempted to measure the effect of obesity on perioperative outcomes 8 with equivocal results, but may have been limited by its dependence on billing data to differentiate obese and non-obese subjects.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

et al. 2017

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Background Extreme BMI (either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of body-mass index (BMI) on perioperative outcomes in congenital heart disease patients has not been evaluated. Methods A multicenter retrospective cohort study was performed studying patients 10–35 years undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between 1/1/2010–12/31/2015. The primary outcomes were operative mortality and a composite outcome (one or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age and sex-adjusted BMI percentiles and these outcomes were assessed, adjusting for patient level risk factors, using multivariate logistic regression. Results Of 18,337 patients (118 centers), 16% were obese, 15% overweight, 53% normal weight, 7% underweight and 9% were severely underweight. Observed risks of operative mortality (p=0.04) and composite outcome (p<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (OR: 1.28 p=0.008), severely underweight (OR: 1.29 p<0.0001) and underweight subjects (OR: 1.39 p=0.002) subjects were associated with increased risk of composite outcome. Conclusion Obesity and underweight BMI were associated with increased risk of composite adverse outcome independent of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

et al. 2017

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“…Obesity has significant health consequences in congenital heart disease (CHD) including increased postoperative mortality and hospital utilization and would be disadvantageous for patients requiring multiple procedures . There is controversy in the literature on the prevalence of obesity in children with CHD.…”

Section: Introductionmentioning

confidence: 99%

“…Some other studies inferred that the obesity rates in children with CHD are likely much higher than the general population . Data analyzed in previous studies are over 10 years old; while it is known in the general population that the risk of obesity has increased in the last 10 years with the “obesity epidemic,” previous studies on patients with CHD have not defined the timing of overweight and obesity onset which can be critical for preventive efforts.…”

Section: Introductionmentioning

confidence: 99%

Obesity trends in children, adolescents, and young adults with congenital heart disease

Steele

Preminger

Erenberg

et al. 2019

Congenital Heart Disease

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Objectives To determine the prevalence, age of onset, and risk factors for overweight and obesity in children with congenital heart disease (CHD). Study Design Children with CHD who were seen at our institution from 1996 to 2017 were studied. Patients were full‐time residents of the United States and were receiving all cardiac care at our institution. Patients were categorized by age and CHD diagnosis. The date of last normal weight for age and the date of first recorded weight in the range of overweight and obese were documented. Results Nine hundred sixty‐eight patients with CHD were included. The prevalence of overweight and obesity was 31.5% and 16.4%, respectively. For patients who became overweight or obese, the last recorded normal weight was between 6 and 10 years of age. Electrophysiologic disease and older age were risk factors for obesity. Conclusions Children with CHD have an increasing risk of becoming overweight and obese in early childhood. This study provides important information and identifies critical period to implement preventative measures and counsel families about the risk of obesity in CHD.

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“…In previous analyses of ACHD surgery, male gender and older age have been associated with increased mortality . Obesity and diabetes mellitus have been noted to increase postoperative morbidity as well as hospital utilization after cardiac surgery in children's hospitals, but specific effects of diabetes mellitus on mortality in this patient population have not been reported. Limited data regarding the role of coronary artery disease in outcomes after ACHD surgery shows that overall outcomes are similar between matched populations with and without coronary artery bypass grafting, but survival was decreased in certain patient populations, particularly women .…”

Section: Discussionmentioning

confidence: 95%

Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children's hospitals

Dolgner

Krieger

Wilkes

et al. 2019

Congenital Heart Disease

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Objective Adult congenital heart disease (ACHD) patients who undergo cardiac surgery are at risk for poor outcomes, including extracorporeal membrane oxygenation support (ECMO) and death. Prior studies have demonstrated risk factors for mortality, but have not fully examined risk factors for ECMO or death without ECMO (DWE). We sought to identify risk factors for ECMO and DWE in adults undergoing congenital heart surgery in tertiary care children's hospitals. Design All adults (≥18 years) undergoing congenital heart surgery in the Pediatric Health Information System (PHIS) database between 2003 and 2014 were included. Patients were classified into three groups: ECMO‐free survival, requiring ECMO, and DWE. Univariate analyses were performed, and multinomial logistic regression models were constructed examining ECMO and DWE as independent outcomes. Setting Tertiary care children's hospitals. Results A total of 4665 adult patients underwent ACHD surgery in 39 children's hospitals with 51 (1.1%) patients requiring ECMO and 64 (1.4%) patients experiencing DWE. Of the 51 ECMO patients, 34 (67%) died. Increasing patient age, surgical complexity, diagnosis of single ventricle heart disease, preoperative hospitalization, and the presence of noncardiac complex chronic conditions (CCC) were risk factors for both outcomes. Additionally, low and medium hospital ACHD surgical volume was associated with an increased risk of DWE in comparison with ECMO. Conclusions There are overlapping but separate risk factors for ECMO support and DWE among adults undergoing congenital heart surgery in pediatric hospitals.

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Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals

Abstract: The presence of obesity or diabetes mellitus was associated with increased postoperative morbidity, hospital utilization, and cost in patients undergoing cardiac surgery in pediatric hospitals.

Cited by 18 publications

References 24 publications

Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

Obesity trends in children, adolescents, and young adults with congenital heart disease

Predictors of extracorporeal membrane oxygenation support after surgery for adult congenital heart disease in children's hospitals

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