Masakazu Saioth1, Kenta Kamisaka2, Michitaka Kato3, Kentaro Iwata4, Koji Sakurada5, Masayuki Tahara6, Keisuke Oura7, Yuji Mori8, Shota Otuka9, Tomoyuki Morisawa10, Tetsuya Takahashi10. 1. Department of Rehabilitation, Sakakibara Heart Institute, 1-3-16, Asahi-chu, Fuchu, Tokyo, 1830003, Japan. msaitoh@shi.heart.or.jp. 2. Rehabilitation Center, Kitano Hospital, Osaka, Japan. 3. Department of Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan. 4. Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan. 5. Department of Rehabilitation, The Cardiovascular Institute, Tokyo, Japan. 6. Department of Rehabilitation, Higashi Takarazuka Satoh Hospital, Takarazuk, Japan. 7. Department of Rehabilitation, Kansai Electric Power Hospital, Osaka, Japan. 8. Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan. 9. Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 10. Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.
Abstract
OBJECTS: The aim of this study was to determine the association between underweight or obese status and hospital- acquired functional decline (HAFD) following cardiovascular surgery. METHODS: We performed a retrospective, observational, multicenter cohort study of cardiovascular surgery patients between April, 2010, and June, 2017. Body mass index (BMI) was categorized into four classes: underweight group (< 18.5 kg/m2), normal weight group (18.5 to < 25 kg/m2), overweight group (25 to < 30 kg/m2), and obese group (≥ 30 kg/m2). HAFD was defined as a decrease of at least one point on the short physical performance battery score at discharge, compared with the preoperative score. RESULTS: A total of 3,850 adult patients were included in the analysis data set (median age 72 years, 35% female). A total of 811 (21.0%) patients demonstrated HAFD: 27.2% in the underweight group, 21.3% in the normal weight group, 18.8% in the overweight group, and 19.3% in the obese group. The relative risk for HAFD was 1.381 (95% CI 1.052-1.814) for the underweight group versus the normal weight group, although that is comparable to the obese group after adjustment by confounding factors. Analyses of subgroup interactions showed that the relative risk of HAFD in the obese group compared with the normal group was higher in patients with muscle wasting (p < 0.05). CONCLUSION: HAFD was significantly worse for underweight patients following cardiovascular surgery. In contrast, obese status was not associated with HAFD, exclusive of the obese patients with muscle wasting.
OBJECTS: The aim of this study was to determine the association between underweight or obese status and hospital- acquired functional decline (HAFD) following cardiovascular surgery. METHODS: We performed a retrospective, observational, multicenter cohort study of cardiovascular surgery patients between April, 2010, and June, 2017. Body mass index (BMI) was categorized into four classes: underweight group (< 18.5 kg/m2), normal weight group (18.5 to < 25 kg/m2), overweight group (25 to < 30 kg/m2), and obese group (≥ 30 kg/m2). HAFD was defined as a decrease of at least one point on the short physical performance battery score at discharge, compared with the preoperative score. RESULTS: A total of 3,850 adult patients were included in the analysis data set (median age 72 years, 35% female). A total of 811 (21.0%) patients demonstrated HAFD: 27.2% in the underweight group, 21.3% in the normal weight group, 18.8% in the overweight group, and 19.3% in the obese group. The relative risk for HAFD was 1.381 (95% CI 1.052-1.814) for the underweight group versus the normal weight group, although that is comparable to the obese group after adjustment by confounding factors. Analyses of subgroup interactions showed that the relative risk of HAFD in the obese group compared with the normal group was higher in patients with muscle wasting (p < 0.05). CONCLUSION: HAFD was significantly worse for underweight patients following cardiovascular surgery. In contrast, obese status was not associated with HAFD, exclusive of the obesepatients with muscle wasting.