Objectives Body mass index (BMI) is commonly used in obesity classification as a surrogate measure and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate BMI on short-term outcomes after cardiac surgery. Design A retrospective cohort study. Setting University teaching hospital, two centers. Participants The study consisted of 4,740 patients who underwent cardiac surgery of two hospitals from July 1, 2001 to June 30, 2013 in one hospital and from September 1, 2003 to August 31, 2014 in another hospital were included in this study. Interventions No changes to standard practice were required. Measurements and Main Results They were assigned into six BMI groups as follows: Underweight BMI < 18.5 kg/m2), Normal weight (18.5 ≤ BMI < 25 kg/m2), Overweight (25 ≤ BMI < 30 kg/m2), Class I (30 ≤ BMI < 35 kg/m2), Class II (35 ≤ BMI < 40 kg/m2) and Class III obese (BMI ≥ 40 kg/m2). Short-term major postoperative complications (post-operative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, ICU readmission, total ICU hours and readmission in 30 days) and mortalities (in-hospital mortality, 30-day mortality, operative mortality) were compared among various BMI groups after cardiac surgery. Age, gender, surgery type, family history of CAD, diabetes, hypertension, heart failure and lipid lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that being Underweight or Class III obese may present with significant differences of some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter and renal failure. However, being Overweight or Class I obese has a positive impact on discharge mortality and operative mortality. Conclusions The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an “obese paradox” in short-term mortality after cardiac surgery.

Objective: The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery.Design: Retrospective investigation. Setting: Patients from a single tertiary medical center. Participants: A total of 505 patients (Z65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery. CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not (Non-Dex group).Interventions: Perioperative Dex intravenous infusion (0.24 to 0.6 μg/kg/h) initiated after cardiopulmonary bypass and continued for o24 hours postoperatively in the ICU.Measurements and Main Results: Data were risk adjusted, propensity score weighted, and multivariate logistic regression was used. The primary outcome was mortality. Secondary outcomes included postoperative stroke, coma, myocardial infarction, heart block, cardiac arrest, delirium, renal failure, and sepsis. Perioperative Dex infusion significantly decreased in-hospital mortality (0.90% v 2.83%; adjusted odds ratio (OR), 0.099; 95% confidence interval (CI), 0.030-0.324; p ¼ 0.004) and operative mortality (1.35% v 3.18%; adjusted OR, 0.251; 95% CI, 0.077-0.813; p ¼ 0.021). Perioperative Dex treatment also reduced the risk of stroke (0.90% v 1.77%; adjusted OR, 0.15; 95% CI, 0.038-0.590; p ¼ 0.007), and delirium (7.21% v 10.95%; adjusted OR, 0.35; 95% CI, 0.212-0.578; p o 0.0001).Conclusions: Results from this study (ClinicalTrials.gov identifier: NCT01683448) suggested perioperative use of dexmedetomidine was associated with decreases in inhospital and operative mortality in elderly patients following cardiac surgery. It also reduced incidences of postoperative stroke and delirium in elderly patients.

Objective: The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery.Design: Retrospective investigation. Setting: Patients from a single tertiary medical center. Participants: A total of 505 patients (Z65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery. CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not (Non-Dex group).Interventions: Perioperative Dex intravenous infusion (0.24 to 0.6 μg/kg/h) initiated after cardiopulmonary bypass and continued for o24 hours postoperatively in the ICU.Measurements and Main Results: Data were risk adjusted, propensity score weighted, and multivariate logistic regression was used. The primary outcome was mortality. Secondary outcomes included postoperative stroke, coma, myocardial infarction, heart block, cardiac arrest, delirium, renal failure, and sepsis. Perioperative Dex infusion significantly decreased in-hospital mortality (0.90% v 2.83%; adjusted odds ratio (OR), 0.099; 95% confidence interval (CI), 0.030-0.324; p ¼ 0.004) and operative mortality (1.35% v 3.18%; adjusted OR, 0.251; 95% CI, 0.077-0.813; p ¼ 0.021). Perioperative Dex treatment also reduced the risk of stroke (0.90% v 1.77%; adjusted OR, 0.15; 95% CI, 0.038-0.590; p ¼ 0.007), and delirium (7.21% v 10.95%; adjusted OR, 0.35; 95% CI, 0.212-0.578; p o 0.0001).Conclusions: Results from this study (ClinicalTrials.gov identifier: NCT01683448) suggested perioperative use of dexmedetomidine was associated with decreases in inhospital and operative mortality in elderly patients following cardiac surgery. It also reduced incidences of postoperative stroke and delirium in elderly patients.

Objectives: Body mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery.Design: A retrospective cohort study. Setting: University teaching hospital, 2 centers. Participants: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from Interventions: No changes to standard practice were required.Measurements and Main Results: Patients were assigned into 6 BMI groups as follows: underweight (BMI o18.5 kg/ m 2 ), normal weight (Z18.5 to o25 kg/m 2 ), overweight (Z25 to o30 kg/m 2 ), class I obese (Z30 to o35 kg/m 2 ), class II obese (Z35 to o40 kg/m 2 ), and class III obese (BMI Z40 kg/ m 2 ). Short-term major postoperative complications (postoperative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, intensive care unit readmission, total intensive care unit hours, and readmission in 30 days, and mortalities (in-hospital mortality, 30-day mortality, surgical mortality) were compared among various BMI groups after cardiac surgery. Age, sex, surgery type, family history of coronary artery disease, diabetes, hypertension, heart failure, and lipid-lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that the underweight and class III obese BMI groups demonstrated significant, adverse differences in some shortterm outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter, and renal failure. However, being in the overweight or class I obese group demonstrated a positive effect on discharge and surgical mortality.Conclusions:The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an "obese paradox" in short-term mortality after cardiac surgery.

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