Abstract
Objectives
: Despite inherent comorbidities, obese cardiac surgical patients paradoxically had
shown lower morbidity and mortality, although the nature of this association is still
unclear. Thus, we intended in this large registry-based study, to investigate the
impact of obesity on short- and long-term postoperative outcomes, with focus on bleeding
and transfusion requirements.
Design
: Retrospective registry study.
Setting
: Three university hospitals
Participants
: A cohort of 12,330 prospectively compiled data from CABG patients operated between
2007-2020 was retrieved from the West Denmark Heart Registry.
Interventions
. The parameters were analyzed to assess the association between body mass index (BMI)
and the selected outcome parameters.
Measurements and main results
: The crude data showed a clear statistically significant association in postoperative
drainage from 637 (418-1108) ml in underweight patients with BMI < 18.5 kg/m2 to 427 (295-620) ml in severe obese patients with BMI ≥ 40 kg/m2 (P<0.0001, Kruskal-Wallis). Further, 50.0 % of patients with BMI < 18.5 received
average 451 ml/m2 in red blood cell transfusions, compared to 16.7 % patients with BMI > 40 receiving
84 ml/m2. The obese groups were less often submitted to re-exploration due to bleeding and
fewer received perioperative hemostatics, inotropes and vasoconstrictors. The crude
data showed increasing 30-day and 6-month mortality with lower BMI, while the one-year
mortality showed a V-shaped pattern, but BMI had no independent impact on mortality
in logistic regression analysis.
Conclusion
: Patients with high BMI may carry a protection to postoperative bleeding after cardiac
surgery, probably secondary to inherent hypercoagulable state, while underweight patients
carry a higher risk in bleeding and outcomes.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
ACS (Acute coronary syndrome), BMI (Body mass index), CABG (Coronary arterial bypass grafting), CPB (Cardiopulmonary bypass), CPR (Central Personal Register), CL (Confidence limit), ECC (Extra corporeal circulation), IQR (Interquartile range), ICU (Intensive care unit), INR (International normalized ratio), LMW (Low molecular weight), OR (Odds-ratio), PCI (, Percutaneous coronary intervention), RBC (Red blood cells), VTE (Venous thromboembolism), WDHR (Western Denmark Heart Registry)To read this article in full you will need to make a payment
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Article info
Publication history
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In Press Accepted ManuscriptIdentification
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