title: Obesity is a risk factor for failure of "fast track" extubation following coronary artery bypass surgery.
abstract: OBJECTIVE
  Obesity is a common comorbid condition among patients undergoing coronary bypass surgery. Previous studies have shown inconsistent results as to whether obese patients require prolonged ventilation after cardiac surgery. Fast track recovery strategies have become common to reduce the duration of ventilation and intensive care. The purpose of this study was to determine whether, in our practice, obesity affects post-operative ventilation time using a fast track recovery strategy.
  
  
  METHODS
  A retrospective continuous quality improvement audit of 200 patient records was performed. Patients were divided into Obese and Non-obese groups using a definition for obesity of body mass index >or= 30.0. Failure of fast track extubation was defined as intubation > six hours.
  
  
  RESULTS
  Eighty-four (42.4%) of the patients audited met criteria for obesity. Although most patients successfully underwent fast track recovery, time to extubation was prolonged, and failure of fast track extubation was more common, in obese patients (63% Non-obese vs 46% Obese extubated in < two hours, 98% Non-obese and 85% Obese patients extubated in < six hours, P < 0.001). Increased body mass index, duration of operative time and postoperative serum creatinine were risk factors for failed fast track extubation among the obese patients. Postoperative blood loss through chest drains was reduced in obese patients.
  
  
  CONCLUSIONS
  While most obese patients can undergo a fast track recovery strategy following cardiac surgery, in our institution the incidence of failure of early extubation is significantly higher than in non-obese patients. Our experience may assist in resource planning for postcardiac surgery patients.
authors.affiliation: Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada. parlowj@post.queensu.ca
authors.forename: Joel L
authors.initials: JL
authors.lastname: Parlow
authors.forename: Richard
authors.initials: R
authors.lastname: Ahn
authors.forename: Brian
authors.initials: B
authors.lastname: Milne
mesh_terms: D015992:Body Mass Index; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors