PURPOSE:The influence of extremely obese body mass (BMI≥50) on outcomes after cardiac surgery has been rarely reported. We analyzed the surgical treatment, perioperative risk factors and the impact of extreme obesity on major clinical outcomes and one-year survival after surgery.
METHODS:Fifty-seven patients of 14,449 patients who underwent cardiac surgery from July 1, 2000 to June 30, 2007 in our hospital were found having BMI 50 or greater. Forty (70%) of these underwent elective surgery. Isolated coronary artery bypass surgery (CABG) was performed on 41 (72%) patients.
RESULTS:Among all extremely obese patients, the mean age was 58±11 years, mean BMI was 55.1kg/m2, and 63% of patients were women. The overall mortality was 9% (5/57), the mortality of isolated CABG surgery was 5% (2/41), and of elective surgery was 5% (2/40). All mortality occurred in women (5 patients). Seventeen patients required emergent/urgent surgery, fifteen patients underwent isolated CABG, and two patients had active endocarditis surgery. Off-pump CABG surgery was performed on 23 patients (54%). Extreme obesity was associated with increased mortality for overall surgery (adjusted odds ration [OR], 2.69; P=0.05), and isolated CABG (adjusted [OR], 3.88; P=0.04), but there was no association between extreme obesity and mortality (adjusted [OR], 1.75; P=0.47) in elective surgery. Extremely obese patients were at increased risk for atrial fibrillation (adjusted [OR], 2.14; P=0.04) and longer intensive care unit stays (adjusted [OR], 2.43; P=0.01). There was no association between extreme obesity and postoperative stroke, myocardial infarction, renal failure, or sternal infection. The 1-year all-cause survival rate was 90.4%.
CONCLUSION:Based on our perioperative and one-year outcomes, cardiac surgery should not be withheld from patients because of extreme obesity. Extreme obesity did not increase the risk of mortality in elective cardiac surgery. The outcomes of extremely obese patients undergoing emergent/urgent cardiac surgery need to be evaluated further.
CLINICAL IMPLICATIONS:Cardiac surgery should not be withheld from patients because of extreme obesity.
DISCLOSURE:Xiumei Sun, No Financial Disclosure Information; No Product/Research Disclosure Information