A Zittermann1, T Becker2, J F Gummert2, J Börgermann2. 1. Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany. Electronic address: azittermann@hdz-nrw.de. 2. Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
Abstract
BACKGROUND AND AIM: There is evidence for a J-shaped association between Body Mass Index (BMI) and all-cause mortality in general populations. In cardiac surgical patients, the effect of BMI on mortality and major adverse cardiac and cerebrovascular events (MACCE) is not completely clear. METHODS AND RESULTS: We investigated the effect of BMI on MACCE (primary endpoint), as well as intensive care unit (ICU)-related outcomes and mid-term mortality in 9125 consecutive patients who were operated on at our institution between July 2009 and July 2012. Of the study cohort, 3.0% were underweight (BMI < 20 kg/m(2)), 28.0% had a normal BMI (20-24.99 kg/m(2)), 43.1% were overweight (BMI 25-29.99 kg/m(2)), 19.3% were obese (BMI 30-34.99 kg/m(2)), and 6.6% were severely obese (BMI ≥ 35 kg/m(2)). Compared with overweight patients (lowest incidence of MACCE), the multivariable-adjusted odds ratio of MACCE in severely obese patients was 1.39 (95% CI: 1.03-1.87). Underweight and severely obese patients had the longest risk-adjusted duration of mechanical ventilator support and ICU stay (P-values 0.004-0.001). The red blood cell concentrates requirement was highest in underweight patients (P < 0.001). Compared with normal and overweight patients, the multivariable-adjusted hazard ratio of 2-year mortality was higher in underweight patients (1.72 [95% CI: 1.26-2.36] and =2.07 [95% CI: 1.51-2.83], respectively), but did not differ significantly in severely obese patients. CONCLUSION: Data demonstrate that both severe obesity and underweight are independent risk factors for operative complications in cardiac surgical patients. With respect to mid-term survival, special attention should be paid to underweight patients scheduled for cardiac surgery.
BACKGROUND AND AIM: There is evidence for a J-shaped association between Body Mass Index (BMI) and all-cause mortality in general populations. In cardiac surgical patients, the effect of BMI on mortality and major adverse cardiac and cerebrovascular events (MACCE) is not completely clear. METHODS AND RESULTS: We investigated the effect of BMI on MACCE (primary endpoint), as well as intensive care unit (ICU)-related outcomes and mid-term mortality in 9125 consecutive patients who were operated on at our institution between July 2009 and July 2012. Of the study cohort, 3.0% were underweight (BMI < 20 kg/m(2)), 28.0% had a normal BMI (20-24.99 kg/m(2)), 43.1% were overweight (BMI 25-29.99 kg/m(2)), 19.3% were obese (BMI 30-34.99 kg/m(2)), and 6.6% were severely obese (BMI ≥ 35 kg/m(2)). Compared with overweight patients (lowest incidence of MACCE), the multivariable-adjusted odds ratio of MACCE in severely obesepatients was 1.39 (95% CI: 1.03-1.87). Underweight and severely obesepatients had the longest risk-adjusted duration of mechanical ventilator support and ICU stay (P-values 0.004-0.001). The red blood cell concentrates requirement was highest in underweight patients (P < 0.001). Compared with normal and overweight patients, the multivariable-adjusted hazard ratio of 2-year mortality was higher in underweight patients (1.72 [95% CI: 1.26-2.36] and =2.07 [95% CI: 1.51-2.83], respectively), but did not differ significantly in severely obesepatients. CONCLUSION: Data demonstrate that both severe obesity and underweight are independent risk factors for operative complications in cardiac surgical patients. With respect to mid-term survival, special attention should be paid to underweight patients scheduled for cardiac surgery.
Authors: Iyare O Esemuede; Alice C A Murray; Steven A Lee-Kong; Daniel L Feingold; Ravi P Kiran Journal: J Gastrointest Surg Date: 2014-10-21 Impact factor: 3.452
Authors: Jesse Guardado; Evie Carchman; Ashley E Danicic; Javier Salgado; Andrew R Watson; James P Celebrezze; David S Medich; Jennifer Holder-Murray Journal: J Gastrointest Surg Date: 2015-12-22 Impact factor: 3.452