Effects of body mass index on early outcome of coronary artery bypass surgery.
ABSTRACT Obesity is commonly thought to be a risk factor for morbidity and mortality after cardiac surgery. The aim of the present study is to evaluate the effects of variations in body mass index on in-hospital outcome of coronary artery bypass grafting (CABG).
The authors conducted a retrospective review of 10191 consecutive patients who had undergone isolated CABG at the center from February 2002 to November 2006. Patients were divided into four groups according to Body Mass Index (BMI). Underweight patients (BMI<18.5 kg/m(2)) were assigned to group 1 and obese patients (BMI 30 kg/m(2)) were put into group 4. Patients with normal BMI and those who were overweight were placed in group 2 and 3 respectively.
Analysis of the BMI groups showed: of 10191 patients 0.7% was underweight; 31.2% of cases had normal BMI, 47.1%; overweight and 21.0% were obese. Compared with other groups, the members of the obese group were younger, included more women and were more likely to have all the risk factors for coronary artery disease except for cigarette smoking (P<0.0001). The underweight patients had an excess of left main coronary artery disease, previous history of myocardial infarction. In-hospital mortality did not show any difference between groups (P=0.46). There was a significant increase in postoperative gastrointestinal complications among the underweight group in comparison with other groups (P=0.027).
According to this study, obese patients undergoing CABG are not at a greater risk of perioperative death and other adverse outcomes compared to normal weight. After CABG, underweight patients are at higher risk of developing gastrointestinal complications compared to normal patients.
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ABSTRACT: We investigated the distribution of early clinical outcomes among normal, obese, and morbidly obese patients undergoing open heart surgery. Medical records of 1,000 patients undergoing open heart surgery since February 2011 at our hospital were investigated retrospectively after permission was obtained from the Council of Education Planning of the hospital. The comorbidities and perioperative and discharge data were analyzed for 279 patients with a body mass index (BMI) score between 18 and <30 [non-obese reference group (NRG, n = 279)]; 166 patients with BMI between 30 and <35 [obese group (OG, n = 166); and 192 seriously obese patients with BMI ≥35 [extreme obese group (EOG, n = 192)]. Distribution of the patients according to BMI scores was found to represent the BMI distribution of the Turkish population. Pulmonary and infective complications were significantly higher in EOG patients compared to NRG based on crude confidence interval. Based on adjusted multiple logistic regression analysis, by adjusting the effects of age, sex, comorbidities (diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease), and smoking, the incidence of pulmonary and gastrointestinal complications in EOG was higher compared to NRG. Discharge with morbidity was significantly higher in OG and EOG compared to NRG. We found that obesity does not increase short-term mortality for open heart surgery; however, it increases the risk of postoperative pulmonary and gastrointestinal complications and discharge with morbidity.Journal of Anesthesia 04/2012; 26(5):702-10. · 1.12 Impact Factor
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ABSTRACT: BACKGROUND: Despite the medical hazards of obesity, recent reports examining body mass index (BMI) show an inverse relationship with morbidity and mortality in the surgical patient. This phenomenon is known as the 'obesity paradox'. The aim of this review is to summarize both the literature concerned with the obesity paradox in the surgical setting, as well as the theories explaining its causation. METHODS: PubMed was searched to identify available literature. Search criteria included obesity paradox and BMI paradox, and studies in which BMI was used as a measure of body fat were potentially eligible for inclusion in this review. RESULTS: The obesity paradox has been demonstrated in cardiac and in non-cardiac surgery patients. Underweight and morbidly obese patients displayed the worse outcomes, both postoperatively as well as at long-term follow-up. Hypotheses to explain the obesity paradox include increased lean body mass, (protective) peripheral body fat, reduced inflammatory response, genetics and a decline in cardiovascular disease risk factors, but probably unknown factors contribute too. CONCLUSIONS: Patients at the extremes of BMI, both the underweight and the morbid obese, seem to have the highest postoperative morbidity and mortality hazard, which even persists at long-term. The cause of the obesity paradox is probably multi-factorial. This offers potential for future research in order to improve outcomes for persons on both sides of the 'optimum BMI'.The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 03/2013; · 2.21 Impact Factor
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ABSTRACT: Analiza tolerancji wysiłku oraz ocena zmęczenia u pacjentów po pomostowaniu tętnic wieńcowych poddanych rehabilitacji kardiologicznej Analysis of Exercise Tolerance and Fatigue Evaluation in Patients after Coronary Artery Bypass Grafting Undergoing Cardiac Rehabilitation 1 Szpital Wojewódzki nr 2 w Rzeszowie 2 Instytut Fizjoterapii Uniwersytetu Rzeszowskiego 3 Szpital Uzdrowiskowy "Eskulap" w Rymanowie Zdroju PRACE oRyGinAlnE ABsTRACT introduction: Coronary heart disease is one of the most common causes of disability and mortality. In order to reduce the risk of acute coronary syndrome, a large group of patients is referred to the cardiac surgery involving coronary artery bypass grafting. The patients after the procedure should be covered by rehabilitation program which has beneficial effects e.g. improving the quality of life of a patient. The aim of the study was to evaluate the conversion in tolerance of exercise and subjective fatigue assessment of patients after coronary artery bypass undergoing rehabilitation. Material and Methods: The subjects of the study were 158 patients treated in the period from February to July 2011. The patients were divided into three age groups. The condition on the admission to treatment and after rehabilitation was assessed in total as well as separately for women and men. On the basis of BMI, the subjects were divided into obese, overweight people and those with normal weight. 6-minute sTREszCzEniE Wstęp: Choroba niedokrwienna serca jest jedną z najczęst-szych przyczyn inwalidztwa iumieralności. W celu zmniej-szenia ryzyka wystąpienia ostrego zespołu wieńcowego duża grupa chorych kierowana jest na leczenie kardiochi-rurgiczne polegające na wykonaniu zabiegu pomostowania tętnic wieńcowych. Po przeprowadzonym zabiegu, pacjenci powinni zostać objęci następowym postępowaniem rehabi-litacyjnym, które przynosi korzyści, m.in. w postaci poprawy jakości życia pacjenta. Celem pracy była ocena zamiany tolerancji wysiłku oraz subiektywnej oceny zmęczenia pacjentów po pomostowaniu tętnic wieńcowych poddanych rehabilitacji. Materiał i metoda: Badaniu zostało poddanych 158 pa-cjentów, leczonych w okresie od lutego do lipca 2011 roku. Pacjentów podzielono na trzy grupy wiekowe. Porównywano stan przy przyjęciu na leczenie i po zakończeniu rehabilitacji ogółem – jak również oddzielnie wśród kobiet i mężczyzn. Na podstawie wskaźnika BMI badanych podzielono również Artykuł otrzymano / recived: 6.06.2013 | Zaakceptowano do publikacji / accepted: 4.06.2014 Udział współautorów / Participation of co-authors: A. autor koncepcji i założeń pracy / author of the concept and objectives of paper; B. zbieranie materiału / collection of data; C. realizacja badań / implementation of research; D. opracowanie, analiza i interpretacja wyników / elaborate, analysis and interpretation of data; E. analiza statystyczna danych / statistical analysis; F. przygotowanie manuskryptu / preparation of a manuscript; G. opracowanie piśmiennictwa / working out the literature; H. pozyskanie funduszy / obtaining fundsPrzegląd Medyczny Uniwersytetu Rzeszowskiego i Narodowego Instytutu Leków w Warszawie. 01/2014;