Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

O’Byrne, Michael L.; Kim, Sunghee; Hornik, Christoph P.; Yerokun, Babatunde A.; Matsouaka, Roland; Jacobs, Jeffrey P.; Jacobs, Marshall L.; Jonas, Richard A.

doi:10.1161/circulationaha.116.026778

Cited by 45 publications

(27 citation statements)

References 53 publications

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“…While we found an association between underweight infants and a longer LOS as seen in other studies of underweight pediatric patients, we did not find this association in underweight children but did find an association with excess weight 32,33 . We found that overweight children had a shorter LOS, while obese children had a longer LOS than their normal‐weight counterparts.…”

Section: Discussioncontrasting

confidence: 50%

Determinants of length of stay after pediatric liver transplantation

Covarrubias

Luo

Massie

et al. 2020

Pediatric Transplantation

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Background:We sought to identify factors that are associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. Methods:We identified 2726 infants (≤24 months) and 3210 children (>24 months) who underwent pediatric liver-only transplantation from 2002-2017 using the Scientific Registry of Transplant Recipients. We used multilevel multivariable negative binomial regression to analyze associations between LOS and recipient and donor characteristics and calculated the MLOSR to quantify heterogeneity in LOS across centers. Results:In infants, the median LOS (IQR) was 19 (13-32) days. Hospitalization prior to transplant (ICU ratio: 1.46 1.59 1.70 ; non-ICU ratio: 1.08 1.16 1.23 ), public insurance (ratio: 1.03 1.09 1.15 ), and a segmental graft (ratio: 1.08 1.15 1.22 ) were associated with a longer LOS; thus, we would expect a 1.59-fold longer LOS in an infant admitted to the ICU compared to a non-hospitalized infant with similar characteristics. In children, the median LOS (IQR) was 13 (9-21) days. Hospitalization prior to transplant (ICU ratio: 1.49 1.62 1.77 ; non-ICU ratio: 1.34 1.44 1.56 ), public insurance (ratio: 1.02 1.07 1.13 ), a segmental graft (ratio: 1.20 1.27 1.35 ), a living donor graft (ratio: 1.27 1.38 1.51 ), and obesity (ratio: 1.03 1.10 1.17 ) were associated with a longer LOS. The MLOSR was 1.25 in infants and 1.26 in children, meaning if an infant received a transplant at another center with a longer LOS, we would expect a 1.25-fold difference in LOS driven by center practices alone. Conclusions:While center-level practices account for substantial variation in LOS, consideration of donor and recipient factors can help clinicians provide more personalized counseling for families of pediatric liver transplant candidates. K E Y W O R D S length of stay, liver transplantation, MELD, pediatric, PELD Approximately 600 children with ESLD will undergo liver transplantation annually in the United States, with priority given to the sickest candidates as determined by the PELD/MELD score. 1 Understanding hospital LOS is necessary to provide more personalized counseling and discharge planning for pediatric liver transplant recipients and their families. 2 From a more practical perspective, understanding LOS is important for families when considering how duration of hospitalization will affect other aspects of their lives, such as arranging childcare for siblings, requesting time off work, and coordinating travel between the transplant center and the patient's home. 3 Most importantly, a prolonged hospitalization places pediatric liver transplant recipient at risk for developing hospital-acquired infections.Finally, from a financial perspective, a longer LOS incurs more costs; a longer LOS in adult liver transplant recipients has been tied to increasing costs and resource utilization. 4A previous multi-center study from the pre-PELD/MELD era of pediatric liver transplantation found that recipients...

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Section: Discussioncontrasting

confidence: 50%

Determinants of length of stay after pediatric liver transplantation

Covarrubias

Luo

Massie

et al. 2020

Pediatric Transplantation

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“…Some other studies inferred that the obesity rates in children with CHD are likely much higher than the general population . Data analyzed in previous studies are over 10 years old; while it is known in the general population that the risk of obesity has increased in the last 10 years with the “obesity epidemic,” previous studies on patients with CHD have not defined the timing of overweight and obesity onset which can be critical for preventive efforts.…”

Section: Introductionmentioning

confidence: 99%

“…the last 10 years with the "obesity epidemic," 6,10 previous studies on patients with CHD have not defined the timing of overweight and obesity onset which can be critical for preventive efforts.…”

mentioning

confidence: 99%

Obesity trends in children, adolescents, and young adults with congenital heart disease

Steele

Preminger

Erenberg

et al. 2019

Congenital Heart Disease

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Objectives To determine the prevalence, age of onset, and risk factors for overweight and obesity in children with congenital heart disease (CHD). Study Design Children with CHD who were seen at our institution from 1996 to 2017 were studied. Patients were full‐time residents of the United States and were receiving all cardiac care at our institution. Patients were categorized by age and CHD diagnosis. The date of last normal weight for age and the date of first recorded weight in the range of overweight and obese were documented. Results Nine hundred sixty‐eight patients with CHD were included. The prevalence of overweight and obesity was 31.5% and 16.4%, respectively. For patients who became overweight or obese, the last recorded normal weight was between 6 and 10 years of age. Electrophysiologic disease and older age were risk factors for obesity. Conclusions Children with CHD have an increasing risk of becoming overweight and obese in early childhood. This study provides important information and identifies critical period to implement preventative measures and counsel families about the risk of obesity in CHD.

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“…9 On the other hand, being underweight is an established predictor of morbidity and mortality in acquired heart failure 15 and may be an equally important marker of increased health risk as overweight/obesity in specific CHD populations. 17 In the current study, we sought to investigate the status of BMI in different ACHD lesions and its association with different factors such as age, exercise capacity, and ventricular function in order to prevent and manage subsequent detrimental comorbidity risks. 5,16 To the best of our knowledge, the prevalence of underweight in ACHD patients has not been described previously, although a recent study showed high prevalence of underweight in CHD patients.…”

mentioning

confidence: 99%

“…5,16 To the best of our knowledge, the prevalence of underweight in ACHD patients has not been described previously, although a recent study showed high prevalence of underweight in CHD patients. 17 In the current study, we sought to investigate the status of BMI in different ACHD lesions and its association with different factors such as age, exercise capacity, and ventricular function in order to prevent and manage subsequent detrimental comorbidity risks. that could affect body habitus and those with Eisenmenger physiology, mental retardation, and severe psychological disorders were excluded from the study.…”

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confidence: 99%

Body mass index in adults with congenital heart disease

Zaqout

Vandekerckhove

Michels

et al. 2019

Congenital Heart Disease

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Objective To investigate the status of body mass index (BMI) in adult people with congenital heart disease (ACHD). Methods Five hundred thirty‐nine adults with CHD (53.8% men) were seen in the outpatient clinic from 2013 to 2015 and compared to a reference population (n = 1737). The severity of CHD was categorized as mild, moderate, and severe according to standard guidelines. Patients were categorized based on BMI as underweight (<18.5), overweight (25‐30), or obese (>30). Echocardiography and magnetic resonance imaging were used to measure ventricular function while exercise capacity was estimated via cardiopulmonary exercise test. Results Adults with CHD had slightly lower BMI than the reference group (24.1 ± 4.3 vs 24.6 ± 4.3; P = .012). Men in the mild and severe group (23.9 ± 3.6; 23.3 ± 4.4 vs 25.1 ± 3.7; P = .007; P = .023) and women in the severe group (21.6 ± 3.3 vs 24.2 ± 4.7; P < .001) had lower BMI compared to the reference group. In the subgroups, men with ventricular septal defect, coarctation of aorta/ventricular septal defect and Fontan circulation and women with Fontan circulation had lower BMI than the reference group. Underweight was more prevalent in women with severe lesions compared to the reference group (22.2% vs 3.8%; P < .001). BMI was associated with age and exercise capacity in patients with mild and moderate lesions, while higher BMI was related to better ventricular function in women with Fontan circulation. Conclusion Underweight was more prevalent in ACHD patients with severe lesions. Special attention should be paid to the possible existence of underweight‐related comorbidities.

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Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

Cited by 45 publications

References 53 publications

Determinants of length of stay after pediatric liver transplantation

Determinants of length of stay after pediatric liver transplantation

Obesity trends in children, adolescents, and young adults with congenital heart disease

Body mass index in adults with congenital heart disease

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