Obesity is still a risk factor in coronary artery bypass surgery

Abstract

Objective: Even with the improvements in surgical techniques and perioperative care, obesity is still a risk factor for occurrence of adverse events following cardiac surgery. In this observational, retrospective study, we aimed to document the effects of obesity on surgical outcomes in patients undergoing coronary artery bypass surgery and find out the effects of improvements in cardiac surgery. Methods: Between January 2011 and March 2013, isolated coronary artery bypass surgery was performed on 790 patients. The body mass index values of the patients were calculated and patients were divided into two groups; below 30 were classified as non-obese group whereas above 30 were classified as obese group. The odds ratio was obtained by using univariate analysis in order to document the effects of obesity on outcomes.Results: There were 548 (69.3%) patients in non-obese group, whereas 242 (30.7%) patients in obese group. The cardiopulmonary bypass (80.47±23.58 vs. 80.89±28.46, p=0.449) and aortic clamp times (54.13±16.60 vs. 54.19±19.85, p=0.511) and number of bypass grafts (3.09±1.02 vs. 2.96±1.00, p=0.11) were comparable between the groups. The mean number of fresh frozen plasma used was higher in obese patients (1.37±1.75 vs. 1.48±4.63, p=0.02). Intubation time was higher in obese patients (10.57±6.87 vs. 12.71±35.31, p=0.014). Total amount of postoperative drainage was higher in non-obese patients (766.77±472.27 vs. 648.72±371.39, p<0.001). The superficial infection/mediastenitis (0.4% vs. 2.5%, p=0.012), dehiscence (0.2% vs. 3.7%, p<0.001) and postoperative renal failure rates (4.7% vs. 8.7%, p=0.031) were higher in obese patients. The incidence of atrial fibrillation was lower in obese patients (19.7% vs. 12.8%, p=0.019). The mortality (0.5% vs. 1.7%, p=0.210) and postoperative stroke rates (1.1% vs. 0.8%, p=1.000) were similar in both groups. Conclusion: We documented that obesity is still a risk factor for occurrence of postoperative adverse events. We believe that improved perioperative care together with meticulous regimens can improve postoperative outcomes in patients undergoing coronary artery bypass surgery.

Does Obesity Affect Early Results after Coronary Artery Bypass Grafting?

“…In our case series, demographic data of obese patients differ when compared with non-obese patients. Obese patients have increased prevalence for hypertension and diabetes mellitus, that is consistent with previous reports [8] [27]. We found that female accounted for the majority of our obese patients than non-obese.…”

“…Saleh et al [29] studied the risk factors of prolonged ventilation in patients undergoing CABG and they found that BMI > 35 kg/m 2 was a predictor of prolonged respiratory support. Similar results were observed by Gurbuz et al [8]. No statistical difference in mean ventilation time was seen between obese and non obese patients in some previous reports [30] [31].…”

“…Epidemiologic data indicate that obesity is associated with atherosclerotic heart disease [4] [5]. Most studies comparing the repercussion of overweight and obesity on short and long-term outcomes in patients undergoing myocardial revascularization found that obesity had negative effect on results after cardiac surgery [6] [7] [8]. But in recent years, acceptable results have been documented due to progress in medical management.…”

Impact of High Body Mass Index on Morbidity and Mortality ın Cardiac Surgery Cardiac Surgery and Obesity

“…Obezite pek çok organ ve sistemi önemli derecede etkileyerek hipertansiyon, diabetes mellitus ve KOAH gibi perioperatif komplikasyon oranlarını arttıran risk faktörlerine neden olur. Literatürde kardiyovasküler cerrahi için refere edilen obez olgularda, preoperatif hipertansiyon, diabetes mellitus, kronik akciğer hastalıkları ve hiperlipidemi insidansının daha yüksek oranlarda bulunduğu, yaş aralığı olarak daha genç oldukları ve kadın cinsiyetin daha fazla olduğu gösterilmiştir [5,8,9,13] . Bizim çalışmamızda da obez grupta hipertansiyon, diyabet gibi yandaş hastalıklar ve kadın cinsiyet daha fazla iken, yaş aralıkları benzerdi.…”

“…Gürbüz ve ark. [13] da VKİ≥30 kg/m 2 olgularda ventilasyon süresinin uzadığını ancak alt grup analizinde anlamlı farklılık olmadığını, hastane ve YBÜ kalış sürelerinin benzer olduğunu göstermişler ve bu durumu benzer AKK/KPB sürelerine dayandırmışlardır. Bizim çalışmamızda AKK/KBP süreleri açısından gruplar arasında anlamlı fark yoktu ve postoperatif solunum komplikasyonları obez grupta daha fazla gözlenirken, mekanik ventilasyon, YBÜ ve hastane kalış süreleri açısından gruplar benzer bulundu.…”