Key result
This rationale and design paper describes a prospective observational study to evaluate whether fitness capacity and biomarkers can predict postoperative outcomes in obese patients undergoing elective cardiac surgery, with no clinical results yet reported.
Why the study?
BMI is the primary measure of obesity but ignores fitness and muscle mass, leaving unclear whether fitness capacity and biomarkers can identify obese cardiac surgery patients at risk for adverse outcomes.
Do fitness capacity and biomarkers help identify patients at risk for adverse outcomes when undergoing cardiac surgery better than BMI?
Observational (n=580)
Yes
Do fitness capacity and biomarkers help identify patients at risk for adverse outcomes when undergoing cardiac surgery better than BMI?
The OPOS study aims to evaluate whether fitness capacity and biomarkers can improve risk stratification for adverse postoperative outcomes in obese patients undergoing cardiac surgery.
BMI alone may inadequately stratify cardiac surgery risk; leaves open whether adding cardiopulmonary fitness improves outcome prediction in prospective cohorts.
INTRODUCTION: Increasing levels of obesity worldwide have led to a rise in the prevalence of obesity-related complications including cardiovascular risk factors such as diabetes, hypertension and dyslipidaemia. Healthcare providers believe that overweight and obese cardiac surgery patients are more likely to experience adverse postoperative outcomes. The body mass index (BMI) is the primary measure of obesity in clinical practice, without accounting for a patient's level of cardiopulmonary fitness or muscle mass. The objective of this study is to determine whether fitness capacity of obese cardiac surgical patients and biomarkers, alone or in combination, will help identify patients at risk for adverse outcomes when undergoing cardiac surgery. METHODS AND ANALYSIS: Patients between the ages of 18 and 75 years undergoing elective cardiac surgery are consented to participate in this prospective observational study. Patients will be invited to participate in measures of obesity, functional capacity and exercise capacity assessments, quality of life questionnaires, and blood and tissue sampling for biomarker analysis. The endpoints evaluated are measures other than BMI that could be predictive of short-term and long-term postoperative outcomes. Clinical outcomes of interest are prolonged ventilation, hospital length of stay, renal failure and all-cause mortality. Biomarkers of interest will largely focus on metabolism (lipids, amino acids) and inflammation (adipokines, cytokines and chemokines). ETHICS AND DISSEMINATION: This study has been approved by the institutional review board at the Horizon Health Network. On completion of the study, the results shall be disseminated through conference presentations and publications in peer-reviewed journals. Additionally, the report shall also be diffused more broadly to the general public and the cardiovascular community. TRIAL REGISTRATION NUMBER: NCT03248921.
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Aguiar et al. (2019) conducted an observational in Elective cardiac surgery (n=580). Obesity and fitness capacity vs. Normal weight patients (BMI 18.5-24.9 kg/m²) was evaluated on Composite of in-hospital mortality, prolonged ventilation >24 hours, new-onset renal failure, and wound infection. This rationale and design paper describes a prospective observational study to evaluate whether fitness capacity and biomarkers can predict postoperative outcomes in obese patients undergoing elective cardiac surgery, with no clinical results yet reported.
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