Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults: An Analysis of Data from the Society of Thoracic Surgeons Database
Background—Extreme BMI (either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of body-mass index (BMI) on perioperative outcomes in congenital heart disease patients has not been evaluated.
Methods—A multicenter retrospective cohort study was performed studying patients 10-35 years undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between 1/1/2010-12/31/2015. The primary outcomes were operative mortality and a composite outcome (one or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age and sex-adjusted BMI percentiles and these outcomes were assessed, adjusting for patient level risk factors, using multivariate logistic regression.
Results—Of 18,337 patients (118 centers), 16% were obese, 15% overweight, 53% normal weight, 7% underweight and 9% were severely underweight. Observed risks of operative mortality (p=0.04) and composite outcome (p<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (OR: 1.28 p=0.008), severely underweight (OR: 1.29 p<0.0001) and underweight subjects (OR: 1.39 p=0.002) subjects were associated with increased risk of composite outcome.
Conclusions—Obesity and underweight BMI were associated with increased risk of composite adverse outcome independent of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.
- risk stratification
- wound infection
- body mass index
- congenital heart disease
- outcomes research
- Received December 6, 2016.
- Revision received May 19, 2017.
- Accepted June 5, 2017.