The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons’ database

Prabhakar, Ganga; Haan, Constance K.; Peterson, Eric D.; Coombs, Laura P.; Cruzzavala, Jose; Murray, Gordon F.

doi:10.1016/s0003-4975(02)03899-7

Cited by 175 publications

(131 citation statements)

References 9 publications

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“…There is controversy on the subject and in recent years it is accepted that obesity does not have adverse effects on postoperative renal complications (6, 7). Conversely, Alam et al (5) and Prabhakar et al (8) documented negative effects of obesity on renal functions. The mechanisms postulated are the more common occurrence of diabetes and hypertension in obese patients which increase the likelihood of postoperative renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Obesity is still a risk factor in coronary artery bypass surgery

Gürbüz¹,

Durukan²,

Salman³

et al. 2014

Anadolu Kardiyol Derg

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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.

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Section: Discussionmentioning

confidence: 99%

Obesity is still a risk factor in coronary artery bypass surgery

Gürbüz¹,

Durukan²,

Salman³

et al. 2014

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

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“…The risk for endstage renal disease rises with body mass index (2), and chronic kidney disease is itself an established risk factor for acute kidney injury. Furthermore, in the surgical literature super obesity is associated with higher rates of acute kidney injury as well as other serious complications (3)(4)(5). Third, the super obese spend more time in-hospital compared with less obese individuals, increasing exposure to risk factors associated with acute renal failure (6).…”

Section: Discussionmentioning

confidence: 99%

Challenges of Treating a 466-Kilogram Man With Acute Kidney Injury

Friedman

Decker

Seele

et al. 2008

American Journal of Kidney Diseases

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Caring for super obese patients (body mass index >50) presents a number of complex and unique clinical challenges, particularly when acute kidney injury is present. We describe our experience treating the heaviest individual with acute kidney injury requiring renal replacement therapy reported to date. A 24 year old black man was admitted to our hospital with fevers, vomiting, progressive weakness, shortness of breath, and hemoptysis. Admission weight was 1024 lbs (466 kg), height was 6 ft 4 in (1.9 m), and body mass index was 125. During hospitalization the patient suffered oligoanuric acute kidney injury and required initiation of continuous and, subsequently, intermittent renal replacement therapy. This clinical scenario, which identifies many of the kidney and non-kidney related challenges surrounding the care of super obese patients with acute kidney injury, may be a harbinger of what awaits the nephrology community in the obesity pandemic era.

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“…2007). Others have found that morbid obesity independently predicts perioperative complications as well as operative mortality (Prabhakar et al, 2002). One study by Syrakas and colleagues (2007) even found that normal weight patients had a higher 30-day mortality rate than their obese peers post-surgery.…”

Section: Comorbidity With Coronary Artery Diseasementioning

confidence: 99%