From the Departments of Surgery (N.J.O.B., C.A.S.M.) and Medicine
(E.M.O., G.T.O'C.), Dartmouth Medical School, Hanover, NH; Department of
Surgery, Optima Health Care, Manchester, NH (D.C.C.); Department of Surgery,
Eastern Maine Medical Center, Bangor (F.H.); Department of Surgery, Fletcher
Allen Health Care, Burlington, Vt (B.J.L.); and Department of Surgery, Maine
Medical Center, Portland (J.R.M.).
Correspondence to Nancy J.O. Birkmeyer, PhD, Surgical Outcomes Assessment Program, Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756. E-mail Nancy.J.Birkmeyer{at}dartmouth.edu
Background—Obesity is frequently
cited as a risk factor for adverse outcomes of major surgery. The
results of prior studies of the relationship between obesity and risk
of adverse outcomes of coronary artery bypass grafting (CABG)
have been contradictory because of insufficient power to assess
relatively infrequent outcomes or data to adjust for confounding
factors.
Methods and Results—Data on patient age, sex, height, weight,
medical history, current clinical status, and treatment factors were
assessed prospectively among 11 101 consecutive patients undergoing
CABG. Body mass index (BMI) was used as the measure of obesity and was
categorized as nonobese (1st to 74th percentiles), obese (75th to 94th
percentiles), or severely obese (95th to 100th percentiles). Adverse
outcomes occurring in-hospital, including mortality,
intraoperative/postoperative cerebrovascular accident (CVA),
postoperative bleeding, and sternal wound infection, were defined
prospectively. Associations between obesity and postoperative outcomes
were assessed by use of logistic regression to adjust for potentially
confounding variables. Although obesity was not associated with
increased mortality (adjusted odds ratio [OR], 1.16;
P=.261) or postoperative CVA (adjusted OR, 1.06;
P=.765), risks of sternal wound infection were
substantially increased in the obese (adjusted OR, 2.10; confidence
interval [CI], 1.45 to 3.06; P<.001) and severely
obese (adjusted OR, 2.74; CI, 1.49 to 5.02; P=.001). On
the other hand, rates of postoperative bleeding were significantly
lower in the obese (adjusted OR, 0.66; CI, 0.49 to 0.90;
P=.009) and severely obese (adjusted OR, 0.40; CI, 0.20
to 0.81; P=.011).
Conclusions—With the exception of sternal wound infection, the
perception among clinicians that obesity predisposes to various
postoperative complications with CABG is not supported by these data.
Further work is needed to understand the apparent protective effect of
obesity on risks of postoperative bleeding.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Obesity and Risk of Adverse Outcomes Associated With Coronary Artery Bypass Surgery
Key Words: surgery • risk factors • obesity • morbidity • mortality
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|