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Cardiac surgery and morbid obesity
Miguel Sousa Uva1, Vanessa Rodrigues, Nuno Monteiro
1Departamento de Circulação, Serviço de Cirurgia Cardiotorácica, Hospital da Cruz Vermelha, Lisboa. uvamiguel@hotmail.com
Insights
Morbidly obese patients undergoing cardiac surgery face increased mortality and morbidity risks. However, outcomes were satisfactory for many, with improved quality of life in two-thirds of patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Obesity Medicine
Background:
- Obesity is a known risk factor for complications following cardiac surgery.
- Understanding outcomes in morbidly obese patients is crucial for surgical planning and patient care.
Purpose of the Study:
- To analyze mortality and morbidity rates in patients with morbid obesity (BMI > 35 kg/m2) who underwent cardiac surgery.
- To evaluate the short- and medium-term results and quality of life in this patient population.
Main Methods:
- Retrospective study conducted in a tertiary care setting.
- Inclusion of 50 consecutive morbidly obese adult patients undergoing cardiac surgery between July 1998 and March 2001.
- Procedures included coronary artery bypass grafting (CABG), valve surgery, and combined procedures.
Main Results:
- Hospital mortality was 6% (3 patients).
- Major morbidities included myocardial infarction (8%) and stroke (8%). Superficial wound infections occurred in 15% of patients.
- Mean intensive care unit (ICU) and hospital stays were 2.2 and 6.8 days, respectively. At follow-up, 93% were in NYHA class I or II, and 65% had unrestricted physical activity.
Conclusions:
- Cardiac surgery in morbidly obese patients is associated with elevated risks of morbidity and mortality.
- Despite risks, short- and medium-term outcomes can be satisfactory, with significant improvements in quality of life observed in a majority of patients.
Objective:
Obesity is considered a risk factor for the occurrence of complications after cardiac surgery. The objective of this study was to analyze mortality and morbidity in patients with morbid obesity following heart surgery.
Design:
Retrospective study in a tertiary care setting.
Methods:
Out of 1815 adult patients undergoing cardiac surgery, 50 consecutive patients (3%) with morbid obesity (defined by a body mass index (BMI) > 35 kg/m2) operated on between 7/98 and 3/01 were studied. Mean age was 61.9 +/- 10.4 years, mean BMI was 38.0 +/- 2.7 kg/m2 and mean Parsonnet score was 14.3. Thirty patients had CABG, 14 underwent valve surgery and 6 had combined valve and CABG.
Results:
Three patients died in the first 30 days (hospital mortality = 6%). Four patients had myocardial infarction (8%), 4 patients had stroke (8%) and 13 required blood transfusion (29%). There were no deep sternal wound infections or reoperations but 9 patients (15%) presented superficial wound infections. Mean ICU and hospital stay were 2.2 +/- 2.2 and 6.8 +/- 4.1 days respectively. With a mean follow up of 13.9 +/- 8.9 months, 4 patients died; 38 (93%) out of the 41 patients reviewed are in NYHA class I or II and 27 (65%) have unrestricted physical activity.
Conclusions:
Cardiac surgery in patients with morbid obesity carries a higher morbidity and mortality risk. Short- and medium-term results were satisfactory with improvement in quality of life in two-thirds of the patients.