Cardiac surgery in patients with body mass index of 50 or greater.
BACKGROUND
The seemingly inexorable rise in obesity worldwide is creating a new set of challenges for healthcare providers. Demand for cardiac surgical intervention among patients at extreme levels of obesity (body mass index [BMI] > or = 50) is increasing; however, the risks, benefits, and resources required to meet this need have not been established.


METHODS
Between 1993 and 2004, 57 patients with a BMI of 50 or more underwent cardiac surgical procedures at our institution. The mean BMI was 54 +/- 4, weight range was 124 to 226 kg. The mean age of the study group was 55 +/- 12 years, and comorbidities included diabetes mellitus in 29 (51%), hypertension in 40 (70%), hyperlipidemia in 22 (39%), and obstructive sleep apnea in 16 (28%).


RESULTS
The operative mortality was 7% (4 patients). Eleven patients (20%) required prolonged intubation (more than 24 hours), and mean intensive care unit stay was 5 +/- 9 days. Wound complications requiring surgery occurred in 3 (5%). Survival at 1 and 5 years was 93% +/- 4% and 76 +/- 8%, respectively. By univariate analysis, age and endocarditis were associated with long-term mortality and major perioperative complications. As a dichotomous variable, BMI greater than 54 was a significant predictor of renal failure and prolonged mechanical ventilation.


CONCLUSIONS
Cardiac surgery in the patient with a BMI of 50 or greater is associated with significant resource utilization, including prolonged intensive care unit and hospital stay, with prolonged intubation and wound complications relatively common.
Villavicencio
Mauricio A
MA
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Sundt
Thoralf M
TM
Daly
Richard C
RC
Dearani
Joseph A
JA
McGregor
Christopher G A
CG
Mullany
Charles J
CJ
Orszulak
Thomas A
TA
Puga
Francisco J
FJ
Schaff
Hartzell V
HV
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002423:Cause of Death; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome