BACKGROUND: The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes. METHODS: Primary isolated CABG patients were grouped based on body surface area (BSA, m2) and body mass index (BMI, kg/m2) as follows: 611 very small (BSA < or = 1.70); 933 slightly small (1.70 < BSA < or = 1.85); 945 moderately obese (32 < BMI < 36); 594 very obese (BMI > or = 36); and 3,018 normal (BSA >1.85; BMI = 22 to 32). Subcohorts of very small (371 pairs, 61%), slightly small (717, 77%), moderately obese (874, 92%), and very obese (516, 87%) patients were propensity-matched to normal. RESULTS: Compared with normal, very small had more transfusions (46% versus 32%; p < 0.001), reoperation for bleeding (3.2% versus 0.3%; p = 0.002), and pulmonary edema (2.4% versus 0.5%; p = 0.033). For slightly small, transfusion (41% versus 29%; p < 0.001) and bleeding (2.5% versus 1.0%; p = 0.04) were increased. For moderately obese, sternal wound infections (1.9% versus 0.8%; p = 0.04) were greater. Complications were most frequent in very obese: reoperation (5.2% versus 1.6%; p < 0.001), sternal wound infections (3.5% versus 0.2%; p < 0.001), pulmonary edema (2.9% versus 1.2%; p = 0.047), renal failure (6.0% versus 2.3%; p = 0.003), atrial fibrillation (20% versus 12%; p = 0.001), gastrointestinal problems (3.7% versus 1.6%; p = 0.032), and postoperative stay (8.0 versus 6.4 days; p = 0.003). When slightly small and very small are considered together, operative mortality was significantly greater (3.22% versus 1.65%; p = 0.026). Both very small (risk ratio [RR] = 1.39; p = 0.044) and very obese (RR = 1.44; p = 0.020) were independent predictors of worse 0- to 12-year mortality. CONCLUSIONS: Large deviations from normal body size in either direction--particularly extreme obesity--are associated with increased postoperative morbidity and worse long-term survival.
BACKGROUND: The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes. METHODS: Primary isolated CABG patients were grouped based on body surface area (BSA, m2) and body mass index (BMI, kg/m2) as follows: 611 very small (BSA < or = 1.70); 933 slightly small (1.70 < BSA < or = 1.85); 945 moderately obese (32 < BMI < 36); 594 very obese (BMI > or = 36); and 3,018 normal (BSA >1.85; BMI = 22 to 32). Subcohorts of very small (371 pairs, 61%), slightly small (717, 77%), moderately obese (874, 92%), and very obese (516, 87%) patients were propensity-matched to normal. RESULTS: Compared with normal, very small had more transfusions (46% versus 32%; p < 0.001), reoperation for bleeding (3.2% versus 0.3%; p = 0.002), and pulmonary edema (2.4% versus 0.5%; p = 0.033). For slightly small, transfusion (41% versus 29%; p < 0.001) and bleeding (2.5% versus 1.0%; p = 0.04) were increased. For moderately obese, sternal wound infections (1.9% versus 0.8%; p = 0.04) were greater. Complications were most frequent in very obese: reoperation (5.2% versus 1.6%; p < 0.001), sternal wound infections (3.5% versus 0.2%; p < 0.001), pulmonary edema (2.9% versus 1.2%; p = 0.047), renal failure (6.0% versus 2.3%; p = 0.003), atrial fibrillation (20% versus 12%; p = 0.001), gastrointestinal problems (3.7% versus 1.6%; p = 0.032), and postoperative stay (8.0 versus 6.4 days; p = 0.003). When slightly small and very small are considered together, operative mortality was significantly greater (3.22% versus 1.65%; p = 0.026). Both very small (risk ratio [RR] = 1.39; p = 0.044) and very obese (RR = 1.44; p = 0.020) were independent predictors of worse 0- to 12-year mortality. CONCLUSIONS: Large deviations from normal body size in either direction--particularly extreme obesity--are associated with increased postoperative morbidity and worse long-term survival.
Authors: Castigliano M Bhamidipati; Damien J LaPar; Gaurav S Mehta; John A Kern; Gilbert R Upchurch; Irving L Kron; Gorav Ailawadi Journal: Surgery Date: 2011-10 Impact factor: 3.982
Authors: Antonio Lio; Emanuele Bovio; Francesca Nicolò; Guglielmo Saitto; Antonio Scafuri; Carlo Bassano; Luigi Chiariello; Giovanni Ruvolo Journal: Tex Heart Inst J Date: 2019-02-01
Authors: Mark K Ferguson; Hae Kyung Im; Sydeaka Watson; Elizabeth Johnson; Christopher H Wigfield; Wickii T Vigneswaran Journal: Eur J Cardiothorac Surg Date: 2014-02-05 Impact factor: 4.191
Authors: Salim S Virani; Vijay Nambi; Vei-Vei Lee; MacArthur A Elayda; Wei Pan; Laura A Petersen; James M Wilson; James T Willerson; Christie M Ballantyne Journal: Tex Heart Inst J Date: 2009