Obesity Increases Risk‐Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery

Abstract

BackgroundDespite the epidemic rise in obesity, few studies have evaluated the effect of obesity on cost following cardiac surgery. We hypothesized that increasing body mass index (BMI) is associated with worse risk‐adjusted outcomes and higher cost.Methods and ResultsMedical records for 13 637 consecutive patients who underwent coronary artery bypass grafting (9702), aortic (1535) or mitral (837) valve surgery, and combined valve–coronary artery bypass grafting (1663) procedures were extracted from a regional Society of Thoracic Surgeons certified database. Patients were stratified by BMI: normal to overweight (BMI 18.5–30), obese (BMI 30–40), and morbidly obese (BMI >40). Differences in outcomes and cost were compared between BMI strata and also modeled as a continuous function of BMI with adjustment for preoperative risk using Society of Thoracic Surgeons predictive risk indices. Morbidly obese patients incurred nearly 60% greater observed mortality than normal weight patients. Moreover, morbidly obese patients had greater than 2‐fold increase in renal failure and 6.5‐fold increase in deep sternal wound infection. After risk adjustment, a significant association was found between BMI and mortality (P<0.001) and major morbidity (P<0.001). The risk‐adjusted odds ratio for mortality for morbidly obese patients was 1.57 (P=0.02) compared to normal patients. Importantly, risk‐adjusted total hospital cost increased with BMI, with 17.2% higher costs in morbidly obese patients.ConclusionsHigher BMI is associated with increased mortality, major morbidity, and cost for hospital care. As such, BMI should be more strongly considered in risk assessment and resource allocation.

Effect of Body Mass Index on Morbidity and Mortality in Patients Undergoing Coronary Artery Bypass Grafting

“…In early postoperative period, ventilation time, ICU and hospital stay were significantly higher in group A. Obesity was found to be associated with prolonged mechanical ventilation [8] and several mechanisms contributed to this. Obese patients had slower return to their consciousness and restoration of the muscle power and many anesthetic agents are fat soluble with prolonged duration of action in obese patients due to redistribution.…”

“…Body mass index (BMI) was classified according to the World Health Organization (WHO) into three groups: normal weight (BMI between 18.5 and 24.9 kg/m2), overweight (BMI ≥ 25 Kg/m2 and < 30 Kg/m2), and obese (BMI ≥ 30 Kg/m2) [6,7]. Although higher BMI was associated with major morbidity and increased the cost of healthcare, BMI is not included in several cardiac risk stratification scores [8]. This study aims to evaluate the effect of BMI on early and late morbidity and mortality after CABG in the Egyptian population.…”

Perioperative management of the obese surgical patient

“…184 Morbidly obese patients have 6.5-fold increase in deep sternal wound infection. 185 Interrogation of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for abdominal surgery showed that obesity and morbid obesity are independently associated with overall surgical-site infections development in clean and clean-contaminated cases. 186 Further analysis of the same database addressing 16 major cardiovascular, orthopedic and oncologic surgeries showed that morbid obesity significantly increased the odds of wound complications in all surgeries except for pneumonectomy.…”

Inhibition of food craving is a metabolically active process in the brain in obese men

“…Obesity is associated with significant increases in morbidity and mortality, highlighting the urgency for understanding the processes contributing to this epidemic [1,2]. In many of the current environments, highly palatable and affordable food is widely available.…”