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CLINICAL RESEARCH: CORONARY SURGERY

Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery

Barnaby C. Reeves, DPhil^*, Raimondo Ascione, MD, Martin H. Chamberlain, FRCS and Gianni D. Angelini, FRCS^,*

^* Health Services Research Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
Bristol Heart Institute, University of Bristol, Bristol, England, United Kingdom

Manuscript received August 30, 2002; revised manuscript received March 20, 2003, accepted April 17, 2003.

^* Reprint requests and correspondence: Prof. Gianni D. Angelini, Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, England United Kingdom.
g.d.angelini{at}bristol.ac.uk

OBJECTIVES: This study sought to quantify the effect of body mass index (BMI) on early clinical outcomes following coronary artery bypass grafting (CABG).

BACKGROUND: Obesity is considered a risk factor for postoperative morbidity and mortality after cardiac surgery, although existing evidence is contradictory.

METHODS: A concurrent cohort study of consecutive patients undergoing CABG from April 1996 to September 2001 was carried out. Main outcomes were early death; perioperative myocardial infarction; infective, respiratory, renal, and neurological complications; transfusion; duration of ventilation, intensive care unit, and hospital stay. Multivariable analyses compared the risk of outcomes between five different BMI groups after adjusting for case-mix.

RESULTS: Out of 4,372 patients, 3.0% were underweight (BMI <20 kg/m²), 26.7% had a normal weight (BMI 20 and <25 kg/m²), 49.7% were overweight (BMI 25 and <30 kg/m²), 17.1% obese (BMI 30 and <35 kg/m²) and 3.6% severely obese (BMI 35 kg/m²). Compared with the normal weight group, the overweight and obese groups included more women, diabetics, and hypertensives, but fewer patients with severe ischemic heart disease and poor ventricular function. Underweight patients were more likely than normal weight patients to die in hospital (odds ratio [OR] = 4.0, 95% CI 1.4 to 11.1), have a renal complication (OR = 1.9, 95% confidence interval [CI] 1.0 to 3.7), or stay in hospital longer (>7 days) (OR = 1.7, 95% CI 1.1 to 2.5). Overweight, obese, and severely obese patients were not at higher risk of adverse outcomes than normal weight patients, and were less likely than normal weight patients to require transfusion (ORs from 0.42 to 0.86).

CONCLUSIONS: Underweight patients undergoing CABG have a higher risk of death or complications than normal weight patients. Obesity does not affect the risk of perioperative death and other adverse outcomes compared to normal weight, yet obese patients appear less likely to be selected for surgery than normal weight patients.

Abbreviations and Acronyms   ACT   activated clotting time   BMI   body mass index   CABG   coronary artery bypass grafting   CI   confidence interval   HDU   high dependency unit   ICU   intensive care unit   OR   odds ratio

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