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

Abstract

Objective: Blood loss is a predictor of outcomes after coronary artery bypass grafting (CABG). This study investigated the effects of body mass index (BMI) on blood loss, blood transfusion rate, and the variations in coagulation parameters of Chinese patients undergoing CABG. Methods: A total of 1007 Chinese patients who consecutively underwent isolated, primary CABG at Fuwai Hospital from January 1, 2013 to December 31, 2013 were included in this study. They were categorized by BMI into <24 kg/m 2 (low and normal weight group), 24≤ BMI <28 kg/m 2 (overweight group), and BMI ≥28 kg/m 2 (obese group). Following this BMI classification, the quantities of blood lost and recorded transfusions were analyzed. Results: Blood loss and transfusion rates were significantly higher in the low and normal weight group compared with the obese group (p <0.01). Chest tube drainage over 24 h, duration of intensive care unit (ICU) stay, and postoperative mechanical ventilation were higher as well (p <0.01). Atrial fibrillation was closely related to blood transfusion (p <0.001). Conclusions: Obesity is a predictor for protection against blood loss and transfusion in Chinese people. Patients with low and normal BMI lost more blood per kg of their weight and had higher total transfused volume during isolated primary CABG. Atrial fibrillation was associated with high blood transfusion.

Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis

“…Similar evidence derived from valvular and combined surgery (4). Obese patients require significantly lower rates of re-exploration for bleeding and allogenic blood products transfusions, which are, in turn, major determinants of lung impairment (13,15). Data from a multi-institutional perfusion database demonstrated, that a BMI in obese I category was associated with a 9.9% decrease in transfusion risk (P<0.05).…”

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

“…[5] 13637 hastalık çalışmada obez ve morbid obez grupta daha az kanama ve kan ürünü kullanımı gerektiğini göstermişlerdir. Yine iki farklı çalışmada da, obez olgularda kanama komplikasyonu ve buna bağlı re-operasyon oranlarının daha az olduğu gösterilmiştir [15,18] . Pek çok çalışmada obezitenin daha az kanamayla ilişkisi gösterilmiş ve bunun nedeni olarak, mediastende biriken büyük miktardaki yağ dokusu ve yüksek intraabdominal basıncın, intratorasik basıncı arttırarak kanama alanlarında kompresyon etkisi yaratması, açıklık kazanmasa da obeziteye bağlı hiperkoagülopatik durum ve daha az hemodilüsyon gereksinimi olarak bildirilmiştir [5,[13][14][15]17,18] .…”

Anesthetic and obstetric outcomes in pregnant women undergoing cesarean delivery according to body mass index: Retrospective analysis of a single-center experience

“…Conflicting reports regarding intraoperative blood loss in obese patients undergoing surgery in different settings have been documented. Bowditch et al reported that obese patients having hip replacement surgery bled more compared to patients with normal BMI [ 30 ], whereas Wang et al showed that obesity is a protective factor against the need to receive blood transfusion during coronary artery bypass surgery [ 31 ]. Our study showed that, although blood loss was higher in obese patients, no difference in transfusion rate occurred.…”