The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality

Davenport, Daniel L.; Xenos, Eleftherios S.; Hosokawa, Patrick; Radford, Jacob; Henderson, William G.; Endean, Eric D.

doi:10.1016/j.jvs.2008.08.052

Cited by 210 publications

(157 citation statements)

References 37 publications

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“…Other researchers reported associations between mild obesity and hospital mortality after vascular surgery. This phenomenon is referred to as “reverse” or “paradox” epidemiology or “the obesity paradox” [29]. Also for RRT patients, U-shaped mortality rates have been reported [30], which is in accordance with our findings about AKI-RRT mortality and has been previously noted, particularly the mortality rates of Asian American end-stage renal disease patients [31].…”

Section: Discussionsupporting

confidence: 89%

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: 89%

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

et al. 2017

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“…Yet, most have failed to show that obesity is associated with increased morbidity and mortality after noncardiac surgery. [1][2][3][4][5] The largest study to date, by Mullen et al…”

Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes among Patients with the Modified Metabolic Syndrome Who Are Undergoing Noncardiac Surgery

Glance¹,

Wissler²,

Mukamel

et al. 2010

Anesthesiology

162

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Background:Previous studies have demonstrated that obesity is paradoxically associated with a lower risk of mortality after noncardiac surgery. This study will determine the impact of the modified metabolic syndrome (defined as the presence of obesity, hypertension, and diabetes) on perioperative outcomes. Methods: This study is based on data from 310,208 patients in the American College of Surgeons National Surgical Quality Improvement Program database. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results: Patients with the modified metabolic syndrome who are super obese had a 2-fold increased risk of death (adjusted odds ratio [AOR] 1.99; 95% CI 1.41-2.80). As stratified by body mass index, patients with the modified metabolic syndrome had a 2-to 2.5-fold higher risk of cardiac adverse events (CAE) compared with normal-weight patients: obese (AOR 1.70; 95% CI 1.40 -2.07), morbidly obese (AOR 2.01; 95% CI 1.48 -2.73), and super obese (AOR 2.66; 95% CI 1.68 -4.19). In addition, the risk of acute kidney injury (AKI) was 3-to 7-fold higher in these patients: obese (AOR 3.30; 95% CI 2.75-3.94), morbidly obese (AOR 5.01; 95% CI 3.87-6.49), and super obese (AOR 7.29; 95% CI 5.27-10.1). Conclusion:Patients with the modified metabolic syndrome undergoing noncardiac surgery are at substantially higher risk of complications compared with patients of normal weight.

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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: Discussionmentioning

confidence: 99%

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

Kupper

Karvellas

Khadaroo

et al. 2015

cjs

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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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The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality

Cited by 210 publications

References 37 publications

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

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

Perioperative Outcomes among Patients with the Modified Metabolic Syndrome Who Are Undergoing Noncardiac Surgery

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

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