An Apparent Obesity Paradox in Cardiac Surgery
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Article, see p 850
In this issue of Circulation, Mariscalco and colleagues1 report findings from 2 separate analyses that describe lower in-hospital mortality rates in overweight and obese (class I and class II) patients undergoing cardiac surgery in comparison with leaner patients. Obesity paradoxes are not new to the field of cardiovascular disease and have been observed in heart failure,2 acute coronary syndromes,3 and chronic kidney disease.4 Rather, the novelty of the present study is the authors’ interpretation that the common practice of recommending weight loss before surgery may not be warranted, and that refusing surgery to patients who are morbidly obese should be reconsidered. Although such strong clinical recommendations contradict the extensive body of research describing the risk of significant perioperative complications for obese patients undergoing any type of surgery, the methodologies they used to generate their findings are appropriate and the provocative findings warrant continued discussion.
With the use of both a clinical registry and a meta-analysis, patients in the overweight and class I and class II obesity groups had unadjusted in-hospital and 30-day mortality rates that were half those of patients who were normal weight and almost two-thirds lower than those who were underweight. Two of the most common arguments in opposition to the obesity paradox are that patients who are leaner are sicker and have a higher burden of comorbidities that independently contribute to mortality, or their health behaviors, namely cigarette smoking, contribute directly to …