Key result
In cardiac surgery, obesity class II-III increased operative mortality in women (RR 2.6; 95% CI 1.37-4.81; P=0.002), with height independently associated with lower mortality (OR 0.949; P=0.004).
Why the study?
Although obesity is associated with lower mortality in cardiac surgery, the separate associations of BMI, weight, and height with operative mortality in female and male patients remained unclear.
Does the association between BMI, weight, or height and operative mortality differ by gender in patients undergoing cardiac surgery?
Cohort (n=7,939)
Does the association between BMI, weight, or height and operative mortality differ by gender in patients undergoing cardiac surgery?
The obesity paradox in cardiac surgery appears to be gender-specific, as obesity does not reduce operative mortality in women, whereas height is associated with lower mortality in women and weight in men.
May warrant sex-specific risk stratification in obese women undergoing cardiac surgery; leaves open whether gender-tailored models improve prediction.
OBJECTIVES: In cardiac surgery, obesity is associated with a lower mortality risk. This study aims to investigate the association between body mass index (BMI) and operative mortality separately in female patients and male patients undergoing cardiac surgery and to separate the effects of weight and height in each gender-based cohort of patients. METHODS: A retrospective cohort study including 7939 consecutive patients who underwent cardiac surgery was conducted. The outcome measure was the operative mortality. RESULTS: In men, there was a U-shaped relationship between the BMI and the operative mortality, with the lower mortality rate at a BMI of 35 kg/m2. In women, the relationship is J-shaped, with the lower mortality at a BMI of 22 kg/m2. Female patients with obesity class II-III had a relative risk for operative mortality of 2.6 [95% confidence interval (CI) 1.37-4.81, P = 0.002]. The relationship between weight and mortality rate is a U-shaped bot in men and women, with the lower mortality rate at 100 kg for men and 70 kg for women. Height was linearly and inversely associated with the operative mortality in men and women. After correction for the potential confounders, height, but not weight, was independently associated with operative mortality in women (odds ratio 0.949, 95% CI 0.915-0.983; P = 0.004); conversely, in men, this association exists for weight (odds ratio 1.017, 95% CI 1.001-1.032; P = 0.034), but not height. CONCLUSIONS: Contrary to men, in women obesity does not reduce the operative mortality in cardiac surgery, whereas the height seems to be associated with a lower mortality.
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Ranucci et al. (2018) conducted a cohort in cardiac surgery (n=7,939). Obesity and body mass index vs. Lower BMI / non-obese was evaluated on operative mortality (RR 2.6, 95% CI 1.37-4.81, p=0.002). In cardiac surgery, obesity class II-III increased operative mortality in women (RR 2.6; 95% CI 1.37-4.81; P=0.002), with height independently associated with lower mortality (OR 0.949; P=0.004).
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