What question did this study set out to answer?

To evaluate the impact of varying degrees of elevated body mass index on post-cardiac surgery clinical outcomes and determine whether the obesity paradox exists in this surgical population.

March 17, 2015PLoS ONEOpen Access

The Influence of Body Mass Index on Outcomes in Patients Undergoing Cardiac Surgery: Does the Obesity Paradox Really Exist?

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Why the study?

Does higher body mass index (BMI) influence clinical outcomes and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass?

Population

2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass

Comparison

Overweight, obese, and morbidly obese status vs Normal weight (BMI 18.5-24.9 kg/m2)

Design

Cohort

Follow-up

1 year

Authors

JLJuan Carlos Lopez‐DelgadoHospital Clínic de Barcelona FEFrancisco EsteveBellvitge University Hospital RMRafael MáñezInstitut d'Investigació Biomédica de Bellvitge

Discussion

Member takes

Implication

May inform nuanced perioperative risk assessment by BMI category; leaves open causality of the obesity paradox and requires prospective validation.

Key Points

To evaluate the impact of varying degrees of elevated body mass index on post-cardiac surgery clinical outcomes and determine whether the obesity paradox exists in this surgical population.
Conducted a prospective study of 2,499 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 at a single institution.
Categorized patients by BMI into normal weight (18.5–24.9 kg/m², n=523), overweight (25–29.9 kg/m², n=1,150), obese (30–34.9 kg/m², n=624), and morbidly obese (≥35 kg/m², n=152), tracking 1-year follow-up in 2,379 patients.
Obese patients exhibited elevated risks of perioperative myocardial infarction (OR 1.768; 95% CI: 1.035–3.022; p = 0.037) and septicaemia (OR 1.489; 95% CI: 1.282–1.997; p = 0.005).
Overall in-hospital mortality was 4.8% (n=118), with no statistically significant differences observed between BMI cohorts.
Overweight patients showed higher 1-year survival than normal-weight patients (91.2% vs. 87.6%; Log Rank p = 0.029; HR 1.496; 95% CI: 1.062–2.108; p = 0.021), whereas obesity conferred no survival benefit.

Structured PICO

Does higher body mass index (BMI) influence clinical outcomes and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass?

Population

2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass

Intervention

Overweight (BMI 25-29.9 kg/m2), obese (BMI 30-34.9 kg/m2), and morbidly obese (BMI ≥ 35 kg/m2) status

Comparator

Normal weight (BMI 18.5-24.9 kg/m2)

Outcome

Clinical outcomes after cardiac surgery including in-hospital mortality and 1-year mortalityhard clinical

While overweight patients showed slightly better 1-year survival, obesity itself increased the risk of perioperative myocardial infarction and septicaemia without conferring a survival benefit, challenging the concept of a protective 'obesity paradox' in cardiac surgery.

Cite This Study

Lopez‐Delgado et al. (2015) studied this question.

synapsesocial.com/papers/6a8929b63aa2d8278f76119a https://doi.org/10.1371/journal.pone.0118858

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Implication

May inform nuanced perioperative risk assessment by BMI category; leaves open causality of the obesity paradox and requires prospective validation.

The Influence of Body Mass Index on Outcomes in Patients Undergoing Cardiac Surgery: Does the Obesity Paradox Really Exist?

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

The Influence of Body Mass Index on Outcomes in Patients Undergoing Cardiac Surgery: Does the Obesity Paradox Really Exist?

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Also Consider