BACKGROUND: The increasing number of obese patients eligible for cardiac surgery requires risks and benefits to be balanced in this population. AIMS: To study the results of cardiac surgery in severely obese patients (body mass index [BMI]≥35 kg/m2). METHODS: In this retrospective study of 3564 patients undergoing elective cardiac surgery between 2004 and 2012, the population was divided into two groups: BMI 20-34.9 kg/m2 (n=3282) and BMI≥35 kg/m2 (n=282). Patients with BMI<20 kg/m2 were excluded due to the well-known increased mortality risk. The primary endpoint was 90-day mortality. A multivariable analysis was performed to identify prognostic factors. RESULTS: Among our patients, 58.2% and 27.7% underwent isolated coronary or valvular surgery, respectively; 9.7% had combined valvular and coronary surgery and 4.4% had other procedures. Severely obese patients were younger: 62.5±9.3 years vs 67.8±10.7 years (P=0.0001). Overall 90-day mortality was 4.0%. Severe obesity did not influence postoperative mortality. In the multivariable analysis, the interaction between preoperative renal failure and severe obesity was an important mortality prognostic factor (hazard ratio: 11.17; P=0.03). Mediastinitis rates were similar between groups in non-diabetic patients; in diabetic patients, severe obesity was associated with higher mediastinitis rates (P=0.002). Superficial wound infections were higher in severely obese patients (P=0.003). CONCLUSION: Elective cardiac surgery in severely obese patients was not associated with increased perioperative morbimortality, but had a higher superficial wound infection risk. Nevertheless, severe obesity itself should not be a contraindication to elective surgery.
BACKGROUND: The increasing number of obesepatients eligible for cardiac surgery requires risks and benefits to be balanced in this population. AIMS: To study the results of cardiac surgery in severely obesepatients (body mass index [BMI]≥35 kg/m2). METHODS: In this retrospective study of 3564 patients undergoing elective cardiac surgery between 2004 and 2012, the population was divided into two groups: BMI 20-34.9 kg/m2 (n=3282) and BMI≥35 kg/m2 (n=282). Patients with BMI<20 kg/m2 were excluded due to the well-known increased mortality risk. The primary endpoint was 90-day mortality. A multivariable analysis was performed to identify prognostic factors. RESULTS: Among our patients, 58.2% and 27.7% underwent isolated coronary or valvular surgery, respectively; 9.7% had combined valvular and coronary surgery and 4.4% had other procedures. Severely obesepatients were younger: 62.5±9.3 years vs 67.8±10.7 years (P=0.0001). Overall 90-day mortality was 4.0%. Severe obesity did not influence postoperative mortality. In the multivariable analysis, the interaction between preoperative renal failure and severe obesity was an important mortality prognostic factor (hazard ratio: 11.17; P=0.03). Mediastinitis rates were similar between groups in non-diabeticpatients; in diabeticpatients, severe obesity was associated with higher mediastinitis rates (P=0.002). Superficial wound infections were higher in severely obesepatients (P=0.003). CONCLUSION: Elective cardiac surgery in severely obesepatients was not associated with increased perioperative morbimortality, but had a higher superficial wound infection risk. Nevertheless, severe obesity itself should not be a contraindication to elective surgery.
Authors: Emilio Bouza; Arístides de Alarcón; María Carmen Fariñas; Juan Gálvez; Miguel Ángel Goenaga; Francisco Gutiérrez-Díez; Javier Hortal; José Lasso; Carlos A Mestres; José M Miró; Enrique Navas; Mercedes Nieto; Antonio Parra; Enrique Pérez de la Sota; Hugo Rodríguez-Abella; Marta Rodríguez-Créixems; Jorge Rodríguez-Roda; Gemma Sánchez Espín; Dolores Sousa; Carlos Velasco García de Sierra; Patricia Muñoz; Martha Kestler Journal: J Clin Med Date: 2021-11-26 Impact factor: 4.241