Key result
Overweight status linked to ~70% lower postoperative mortality after aortic valve surgery.
Why the study?
The relationship between BMI and postoperative mortality in aortic valve surgery patients, including the presence and limits of the obesity paradox, was unclear.
Does an overweight or obese BMI status reduce postoperative mortality compared to normal weight in adult patients undergoing aortic valve surgery?
Observational (n=301,250)
Yes
Does an overweight or obese BMI status reduce postoperative mortality compared to normal weight in adult patients undergoing aortic valve surgery?
Odds Ratio: 0.3 (95% CI 0.14–0.66)
Absolute Event Rate: 1.17% vs 3.79%
p-value: p=0.003
In adults undergoing aortic valve surgery, being overweight or mildly obese is associated with significantly lower postoperative mortality compared to normal weight, supporting the existence of a partial obesity paradox.
Overweight status was associated with lower aortic valve surgery mortality; extends obesity paradox observations but should not yet alter risk stratification or practice.
OBJECTIVES: To investigate the relationship between body mass index (BMI) and postoperative mortality in patients undergoing aortic valve surgery, with an emphasis on exploring the presence and limits of the "obesity paradox", the phenomenon wherein overweight and mildly obese patients may experience lower mortality despite obesity's general association with adverse health outcomes. METHODS: The Nationwide Inpatient Sample (NIS) database was used to obtain data from adult patients who underwent aortic valve surgery between 2016 and 2020. BMI categories, as well as comorbidities, were identified using ICD-10 codes. Mortality rates across BMI categories were compared, and multivariate analysis was performed to adjust for comorbid conditions. This is a retrospective observational study. RESULTS: We found 301,250 adult patients who underwent aortic valve surgery. Normal weight patients (n=226,490) had a mortality rate of 3.79%. Overweight (n=2,555) and obese (n=46,320) patients demonstrated significantly lower mortality rates of 1.17% (OR=0.30, 95% CI: 0.14-0.66; P=0.003) and 2.43% (OR=0.63, 95% CI: 0.55-0.73; P<0.001), respectively. Cachectic patients (n=835) had the highest mortality rate at 14.97% (OR=4.47, 95% CI: 2.87-6.96; P<0.001). Morbidly obese patients (n=25,450) had a mortality rate of 4.13%, which was not significantly different from normal-weight patients (OR=1.09, 95% CI: 0.94-1.26; P=0.23). These trends and statistical significance remained after multivariate logistic regression, accounting for demographics and comorbidities. CONCLUSIONS: The partial obesity paradox is true in patients undergoing aortic valve surgery, with the lowest mortality occurring in overweight patients, followed by obese patients, and with cachexia having the highest mortality out of all groups.
No takes yet. Share an insight, caveat, or question.
Feerst et al. (2026) conducted an observational in Aortic valve surgery (n=301,250). Overweight status vs. Normal weight was evaluated on postoperative mortality (OR 0.30, 95% CI 0.14-0.66, p=0.003). Overweight status was associated with lower postoperative mortality compared to normal weight in patients undergoing aortic valve surgery (1.17% vs 3.79%; OR 0.30, 95% CI 0.14-0.66, P=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: