Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery

Abstract

Objective: Obese patients are usually thought to have an increased risk for complications in coronary artery bypass surgery. Methods: Therefore, the data of 500 consecutive patients undergoing coronary artery bypass grafting at our department in 1998 by use of cardiopulmonary bypass were analyzed. Severe obesity was de®ned as body mass index (BMI) $ 30:0 kg/m 2 . Obese patients (n 100; group O) were compared to the remaining 400 patients (group C). Both groups were comparable with respect to sex, history of prior myocardial infarction, chronic obstructive pulmonary disease, previous stroke, duration of cardiopulmonary bypass, aortic cross-clamp time and number of distal anastomoses performed. Obese patients were slightly younger and diabetes and hypertension were more common in these patients. Results: Survival and potential complications including perioperative myocardial infarction, sternal wound infection, wound infection at the leg, renal failure, stroke, prolonged mechanical ventilation, pneumonia, reexploration for bleeding, and atrial arrhythmias were analyzed. No signi®cant differences between obese and non-obese patients were detected. Conclusion: Severe obesity does not necessarily adversely affect perioperative mortality and morbidity in patients undergoing coronary artery bypass grafting in this study. q

Association Between Obesity and Mortality After Acute First-Ever Stroke

“…20 In cases of MI and coronary angioplasty, patients with obesity had better survival and similar rates of cardiac events as compared to patients with normal weight, and these results are very comparable to ours.…”

“…14 -20 In particular, increased BMI was independently associated with better outcome in patients with MI, 14 heart failure, [15][16][17] renal dialysis, 18 percutaneous transluminal coronary angioplasty, 19 and coronary artery bypass surgery. 20 In a recent national U.S. survey of a noninstitutionalized population, among stroke survivors a higher BMI was associated with increased mortality in younger individuals and declined linearly with increasing age. 21 However, there are no data for the relation between obesity and survival in patients who have experienced an acute stroke.…”

The Effects of Different BMI on Blood Loss and Transfusions in Chinese Patients Undergoing Coronary Artery Bypass Grafting

“…The link may be related to the procoagulant state seen in metabolic syndrome and obesity, which is characterized by higher levels of tissue factor and Factor VIII, fibrinogen, inhibition of fibrinolytic pathways (decreased tissue plasminogen activator activity and increased plasminogen activator inhibitor-1), and greater PLT aggregability due to the presence of hyperlipidemia and endothelial dysfunction that is frequently encountered in obese patients. 20,22) Considering the varying risks of adverse outcomes for different BMI groups, it is clear that ours was not the first study to contradict the prevailing view that obesity is a risk factor for operative mortality and morbidity following CABG 23) or to infer that obesity may protect against some adverse outcomes. 24) Several previous studies have suggested that underweight is related to low cardiac output syndrome, strokes, bleeding, and prolonged ventilator therapy.…”

Leptin-Deficient Mice Exhibit Impaired Host Defense in Gram-Negative Pneumonia

“…Obesity may have been an important factor that may have contributed to the observed host defense impairments in the leptin-deficient mice. However, this seems unlikely because obesity was not a significant risk factor for nosocomial pneumonia in human patients (43)(44)(45). Of the abnormalities associated with the leptin-deficient mice, excess glucocorticoid synthesis might have the most potent immune suppressive effects.…”