Effect of Body Mass Index on Outcomes After Cardiac Surgery: Is There an Obesity Paradox?

Stamou, Sotiris C.; Nussbaum, Marcy; Stiegel, Robert M.; Reames, Mark K.; Skipper, Eric; Robicsek, Francis; Lobdell, Kevin W.

doi:10.1016/j.athoracsur.2010.08.047

Cited by 176 publications

(168 citation statements)

References 24 publications

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“…In addition, obese patients have elevations in both kidney plasma flow and glomerular filtration rates, thereby promoting glomerular capillary hypertension, underlying occult and declared structural changes in the kidneys of obese patients [24]. However, our results revealed that although the incidence of AKI correlated with BMI, the mortality of AKI and AKI-RRT patients did not, being lowest in overweight patients and in agreement with previous studies, in which a high BMI had a survival benefit for AKI [13], CS-AKI [26], and cardiac surgery [27] patients. A recent Chinese study about the impact of BMI on the prognosis of AKI in geriatric postoperative major surgery patients revealed that elderly AKI patients of normal weight had a lower mortality risk compared to those who were underweight or obese [28].…”

Section: Discussionsupporting

confidence: 73%

Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

et al. 2017

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Background/Aims: To explore the association of body mass index (BMI) with the risk of developing acute kidney injury after cardiac surgery (CS-AKI) and for AKI requiring renal replacement therapy (AKI-RRT) after cardiac surgery. Methods: Clinical data of 8,455 patients undergoing cardiac surgery, including demographic preoperative, intraoperative, and postoperative data were collected. Patients were divided into underweight (BMI <18.5), normal weight (18.5≤ BMI <24), overweight (24≤ BMI <28), and obese (BMI ≥28) groups. The influence of BMI on CS-AKI incidence, duration of hospital, and intensive care unit (ICU) stays as well as AKI-related mortality was analyzed. Results: The mean age of the patients was 53.2 ± 13.9 years. The overall CS-AKI incidence was 33.8% (n = 2,855) with a hospital mortality of 5.4% (n = 154). The incidence of AKI-RRT was 5.2% (n = 148) with a mortality of 54.1% (n = 80). For underweight, normal weight, overweight, and obese cardiac surgery patients, the AKI incidences were 29.9, 31.0, 36.5, and 46.0%, respectively (p < 0.001). The hospital mortality of AKI patients in the 4 groups was 9.5, 6.0, 3.8, and 4.3%, whereas the hospital mortality of AKI-RRT patients in the 4 groups was 69.2, 60.8, 36.4, and 58.8%, both significantly different (p < 0.05). Hospital and ICU stay durations were not significantly different in the 4 BMI groups. Conclusion: The hospital prognosis of AKI and AKI-RRT patients after cardiac surgery was best when their BMI was in the 24-28 range.

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Section: Discussionsupporting

confidence: 73%

Role of Body Mass Index in Acute Kidney Injury Patients after Cardiac Surgery

et al. 2017

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“…Overall, results are conflicting: some studies are equivocal, 2-4 some show worse outcomes [5][6][7][8][9][10] and others provide evidence of an "obesity paradox," wherein patients who are overweight or mildly obese have better outcomes than those with a healthy weight. [11][12][13][14] Studies assessing obesity and outcomes specifically within general surgery have been similarly inconclusive. 2,9,12 While most studies have assessed the impact of obesity on outcomes following elective surgery, few studies published to date have investigated the impact of obesity on emergency surgery.…”

Section: Resultsmentioning

confidence: 99%

Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study

Kupper

Karvellas

Khadaroo

et al. 2015

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41Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study Background: The aim of this study was to assess perioperative outcomes in obese patients undergoing emergency surgery. Methods:We retrospectively reviewed the charts of all adult (> 17 yr) patients admitted to the acute care emergency surgery service at the University of Alberta Hospital between January 2009 and December 2011 who had a body mass index (BMI) of 35 or higher. Patients were divided into subgroups for analysis based on "severe" (BMI 35-39.9) and "morbid" obesity (BMI ≥ 40). Multivariate logistic regression was performed to identify predictors of in-hospital mortality after controlling for confounding factors.Results: Data on 111 patients (55% women, median BMI 39) were included in the final analysis. Intensive care unit (ICU) support was required for 40% of patients. Postoperative complications occurred in 42% of patients, and 31% required reoperation. Overall in-hospital mortality was 17%. Morbidly obese patients had increased rates of reoperation (40% v. 23%, p = 0.05) and increased lengths of stay compared with severely obese patients (14.5 v. 6.0 d, p = 0.09). Age (odds ratio [OR] 1.08 per increment) and preoperative ICU stay (OR 12) were significantly associated with in-hospital mortality after controlling for confounding, but BMI was not. Conclusion:Obese patients requiring emergency surgery represent a complex patient population at high risk for perioperative morbidity and mortality. Greater resources are required for their care, including ICU support, repeat surgery and prolonged ICU stay. Future studies could help identify predictors of reoperation and strategies to optimize nutrition, rehabilitation and resource allocation.Contexte : Cette étude avait pour objet d'évaluer les résultats périopératoires chez des patients obèses soumis à une chirurgie d'urgence.

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“…[7][8][9][10][11][12][13] Although differing methodologies explain some of this variability, an emerging consensus suggests that the lowest mortality and major morbidity rates occur among adult patients with a BMI of 30 (the traditional boundary between overweight and obese); patients with extreme obesity and patients with extremely low BMI have increased mortality. 10 Similar results have been identified in adult recipients of heart transplants, with low BMI (r18.5) and obesity (BMI Z35) being associated with poorer outcomes.…”

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confidence: 98%

“…4 However, the "obesity paradox," in which overweight patients have better outcomes than patients of normal or low weight when a diagnosis is established, has been increasingly recognized. 3,[5][6][7] The relationship between BMI and surgical outcomes is not straightforward and may vary across procedures.…”

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confidence: 99%