title: Obesity: an independent predictor of in-hospital postoperative renal insufficiency among patients undergoing cardiac surgery?
abstract: We sought to determine, retrospectively, whether obesity was associated with adverse renal outcomes in 17,630 patients who underwent cardiac surgery from January 1995 through December 2006. Obesity was defined as a body mass index > or = 30 kg/m2. The primary outcome was any episode of postoperative renal insufficiency (requiring or not requiring dialysis) before hospital discharge. Outcomes were evaluated in the entire cohort and in subgroups undergoing isolated coronary artery bypass grafting (CABG), isolated valve surgery, and combined CABG and valve surgery. The final analysis included 16,429 patients, 5,124 (31%) of whom were obese. In the entire cohort, obesity was associated both with increased risk of any postoperative renal insufficiency (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.21-1.55) and with increased risk of renal insufficiency not requiring dialysis (OR, 1.41; 95% CI, 1.23-1.62). Obesity was associated with an increased risk of postoperative renal insufficiency in patients undergoing isolated CABG (OR, 1.38; 95% CI, 1.18-1.61), isolated valve surgeries (OR, 1.39; 95% CI, 1.05-1.85), and combined CABG and valve surgeries (OR, 1.35; 95% CI, 0.99-1.83; statistically nonsignificant). Development of postoperative renal insufficiency was associated with a significantly higher mortality rate (P <0.0001) and with a significantly longer hospital stay (23 vs 10.5 days; P <0.0001). We conclude that obesity is associated with a significant increase in postoperative renal insufficiency in cardiac surgery patients, an effect that we attribute to an increase in postoperative renal failure that does not require dialysis.
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: Vei-Vei
authors.initials: VV
authors.lastname: Lee
authors.forename: MacArthur A
authors.initials: MA
authors.lastname: Elayda
authors.forename: Wei
authors.initials: W
authors.lastname: Pan
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: James T
authors.initials: JT
authors.lastname: Willerson
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D057216:Propensity Score; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome