[The impact of morbid obesity on the peri- and postoperative course after aortocoronary bypass surgery].
OBJECTIVE
Excessive obesity is considered to be a risk factor in coronary bypass grafting. The aim of the current study was to examine if grossly overweight patients with a body mass index (BMI) > 35 suffer from higher morbidity and mortality when compared with patients with normal body weight (BMI = 20-25).


METHODS
206 extremely obese patients (group A) and 206 patients with normal body weight (group B) originating from a total of 5614 patients undergoing coronary bypass grafting in the time span between 1.4.1996-1.10.2000 were studied retrospectively and consecutively. The data were obtained from case histories, questionnaires and interviews. Statistical analysis was performed by the chi 2 test after Pearson, the t test and the Kaplan-Meier method depending on the statistical problem analysed using the SPSS software v. 8.0.


RESULTS
The comparison of group A with group B revealed a significantly higher incidence of diabetes mellitus (p < 0.001), hypertension (p < 0.001) and hyperlipidaemia (p < 0.01) in group A. The only significant differences regarding the surgical procedure were the longer operation time (212.3 +/- 44.6 min, mean +/- SD) and aortic cross-clamp time (53.8 +/- 17.4 min, mean +/- SD) in group A (p < 0.05). The duration of mechanical ventilation, the incidence of respiratory insufficiency and the stay in the intensive care unit were not significantly different. The disorders of wound healing both in the sternal and the graft removal regions occurred significantly more frequently in group A (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (2.9%). The follow-up analysis of the 30 days mortality rate in different age groups revealed no significant differences in patients aged between 60 and 75 years. The mean survival rate after 4 years was 87.2% in group A and 86.4% in group B.


CONCLUSIONS
In spite of higher morbidity our results did not reveal significantly higher mortality in extremely obese patients. After operation the patients considered their state improved, therefore elective coronary surgery in grossly overweight patients seems to be indicated also without previous weight reduction.
Ennker
J
J
Herzzentrum Lahr/Baden.
Schoeneich
R
R
Schröder
T
T
Schoeneich
F
F
Ennker
I C
IC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000401:mortality; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors