Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery.
BACKGROUND
Several studies reported increased adverse outcomes after cardiac surgery in patients with low body mass index (BMI; in kg/m(2)). Little is known yet, however, about the effect of preoperative unintended weight loss (UWL) in cardiac surgery patients.


OBJECTIVE
We explored the prevalence and effect of UWL in view of low BMI and vice versa adjusted for a validated set of preoperative risks, inflammatory activity, and duration of extracorporeal circulation on postoperative adverse outcome.


METHODS
A prospective cohort study was performed. Nutritional data of cardiac surgery patients were collected within 24 h of admission and linked to the standard postoperative complication registration database.


RESULTS
The cohort consisted of 331 cases. Multivariate logistic regression analyses showed that preoperative UWL of >or=10% in the past 6 mo (>or=10%UWLin6m) was associated with a prolonged length of stay in the hospital independent from low BMI [odds ratio (OR): 7.06; 95% CI: 1.78, 28.04]. Preoperative BMI <or= 21.0 was associated with an increased incidence of postoperative infections and prolonged stay in the intensive care unit independent from >or=10%UWLin6m (OR: 4.62; 95% CI: 1.20, 17.82; and OR: 5.27; 95% CI: 1.28, 21.76, respectively). Preoperative undernutrition in cardiac surgery patients (>or=10%UWLin6m or BMI <or= 21.0 or both) was present in 9.1% of the study population (4.3% and 4.8%, respectively).


CONCLUSIONS
From this study, we recommend special attention for cardiac surgery patients with preoperative >or=10%UWLin6m or BMI <or= 21.0 because both variables are independently related to adverse outcomes. Preoperative referral to a dietitian for further diagnostic assessment and nutritional treatment is strongly recommended.
van Venrooij
Lenny M W
LM
Divisions of Dietetics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. l.m.vanvenrooij@amc.uva.nl
de Vos
Rien
R
Borgmeijer-Hoelen
Mieke M M J
MM
Haaring
Cees
C
de Mol
Bas A J M
BA
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome; D015431:Weight Loss