title: Severe Obesity Is Associated With Increased Risk of Early Complications and Extended Length of Stay Following Coronary Artery Bypass Grafting Surgery.
abstract: Better understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and in-hospital length of stay following coronary artery bypass grafting surgery.
  
  
  
  We analyzed data from 7560 patients who underwent coronary artery bypass grafting. Using body mass index (BMI; in kg/m(2)) of 18.5 to 24.9 as a reference, the associations of 4 BMI categories (25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40.0) with rates of operative mortality, overall early complications, subgroups of early complications (ie, infection, renal and pulmonary complications), and length of stay were assessed while adjusting for clinical covariates. There was no difference in operative mortality; however, higher risks of overall complications were observed for patients with BMI 35.0 to 39.9 (adjusted odds ratio 1.35, 95% CI 1.11-1.63) and ≥40.0 (adjusted odds ratio 1.56, 95% CI 1.21-2.01). Subgroup analyses identified obesity as an independent risk factor for infection (BMI 30.0-34.9: adjusted odds ratio 1.60, 95% CI 1.24-2.05; BMI 35.0-39.9: adjusted odds ratio 2.34, 95% CI 1.73-3.17; BMI ≥40.0: adjusted odds ratio 3.29, 95% CI 2.30-4.71). Median length of stay was longer with BMI ≥40.0 than with BMI 18.5 to 24.9 (median 7.0 days [interquartile range 5 to 10] versus 6.0 days [interquartile range 5 to 9], P=0.026).
  
  
  
  BMI ≥40.0 was an independent risk factor for longer length of stay, and infection was a potentially modifiable risk factor. Greater perioperative attention and intervention to control the risks associated with infection and length of stay in patients with BMI ≥40.0 may improve patient care quality and efficiency.
authors.affiliation: Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Terada
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Norris
authors.affiliation: Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Raj
authors.initials: R
authors.lastname: Padwal
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Weiyu
authors.initials: W
authors.lastname: Qiu
authors.affiliation: Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
authors.affiliation: Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Wonita
authors.initials: W
authors.lastname: Janzen
authors.affiliation: Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada forhan@ualberta.ca.
authors.forename: Mary
authors.initials: M
authors.lastname: Forhan
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000704:Analysis of Variance; D015992:Body Mass Index; D001026:Coronary Artery Bypass; D048909:Diabetes Complications / Q000150:complications / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality
keywords: cardiovascular disease; diabetes mellitus; health outcomes; infection; surgery