title: Baseline body mass index does not significantly affect outcomes after pulmonary thromboendarterectomy.
abstract: BACKGROUND
  Obesity is a common comorbidity of patients with chronic thromboembolic pulmonary hypertension referred for pulmonary thromboendarterectomy, yet the effect of obesity on pulmonary thromboendarterectomy outcomes has not been well described.
  
  
  METHODS
  We conducted a retrospective cohort study in which 476 consecutive operations over a 3.5-year period were examined to determine the effects of obesity on outcomes. Patients were grouped into four categories based on body mass index (BMI): less than 22 kg/m2, 22 to 30 kg/m2, 30 to 40 kg/m2, and more than 40 kg/m2.
  
  
  RESULTS
  There were important differences in baseline pulmonary hemodynamics, with obese patients having significantly lower pulmonary vascular resistances than nonobese patients. All patients achieved a significant reduction in pulmonary vascular resistance, although the improvement was greatest in the lower BMI groups. The overall in-hospital mortality was 0.8%, and there were no differences in risk among BMI groups. Among the BMI groups, there were no differences in incidence of postoperative complications, including atrial fibrillation (overall 24.8%), reperfusion lung injury (overall 23.1%), and surgical site infection (overall 4.4%) or in median lengths of stay (including ventilator days, intensive care unit days, and postoperative length of stay).
  
  
  CONCLUSIONS
  Pulmonary thromboendarterectomy outcomes have continued to improve, and this surgery can safely be completed in obese patients, previously deemed to be at high risk for poor outcomes.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California. Electronic address: tfernandes@ucsd.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Fernandes
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California.
authors.forename: William R
authors.initials: WR
authors.lastname: Auger
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Fedullo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California.
authors.forename: Nick H
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Poch
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Madani
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Pretorius
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Jamieson
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, California.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Kerr
mesh_terms: D000792:Angiography; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D006328:Cardiac Catheterization; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017131:Thrombectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome