Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery?
BACKGROUND
Obesity has been described as a risk factor for the development of coronary artery disease, but it has not been determined whether obesity is associated with adverse outcomes after cardiac surgery. Therefore, we analyzed a large cohort of patients who had undergone cardiac surgery to determine whether obesity is a predictor of mortality, morbidity or early readmission to hospital.


METHODS
At the London Health Sciences Centre, an academic tertiary care centre, we prospectively entered data from the cardiac surgical database from July 1999 to April 2002. We collected data on 1310 consecutive, unselected patients who underwent cardiac surgery during that time. We assessed the degree of obesity using the body mass index (BMI), and we prospectively documented the occurrence of 10 major complications after surgery. They included stroke, reoperation for bleeding, life-threatening cardiac arrest or arrhythmia, new renal failure requiring dialysis, septicemia, mediastinitis, sternal dehiscence, respiratory failure, postoperative myocardial infarction and low cardiac output necessitating intra-aortic balloon pump use. Univariable and multivariable analyses were conducted to determine the factors associated with and predictive of postoperative death and major complications.


RESULTS
An increased BMI did not increase the risk of early postoperative death. Furthermore, increased BMI was not a predictor of a patient experiencing any of the major complications, except sternal dehiscence. An increased BMI was associated with a higher likelihood of readmission to hospital within 30 days of discharge.


CONCLUSIONS
Obesity was not associated with adverse outcomes after cardiac operations, aside from the increased risks of sternal dehiscence and early hospital readmission.
London Health Sciences Centre, London, Ont.
Marie Antoinette J
MA
Rockx
Stephanie A
SA
Fox
Larry W
LW
Stitt
Kris R
KR
Lehnhardt
F Neil
FN
McKenzie
Mackenzie A
MA
Quantz
Alan H
AH
Menkis
Richard J
RJ
Novick
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D009864:Ontario; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome