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Is obesity a risk factor for mortality in coronary artery bypass surgery?
Ruyun Jin1, Gary L Grunkemeier, Anthony P Furnary
1Providence Health System, Portland, Ore, USA. Ruyun.Jin@providence.org
Insights
Body Mass Index (BMI) is not a significant risk factor for mortality after coronary artery bypass grafting (CABG) surgery. However, patients with high-normal to overweight BMI experienced the lowest mortality rates.
Area of Science:
- Cardiovascular Surgery
- Obesity Research
- Clinical Risk Assessment
Background:
- Conflicting evidence exists regarding the impact of Body Mass Index (BMI) on mortality following Coronary Artery Bypass Grafting (CABG) surgery.
- Previous studies have yielded inconsistent results on whether obesity is a significant risk factor for in-hospital mortality in CABG patients.
Purpose of the Study:
- To investigate the relationship between Body Mass Index (BMI) and in-hospital mortality in patients undergoing Coronary Artery Bypass Grafting (CABG).
- To clarify the role of different BMI categories, including obesity, in predicting surgical outcomes for CABG.
Main Methods:
- Analysis of a large cohort of 16,218 patients who underwent isolated CABG between 1997 and 2003.
- Utilized logistic regression and fractional polynomial transformations to assess BMI's effect on in-hospital mortality.
- Employed cumulative sum techniques to identify mortality trends across various BMI groups.
Main Results:
- Body Mass Index (BMI) was not found to be a statistically significant predictor of in-hospital mortality across various assessment methods.
- Cumulative sum analysis revealed that patients in the high-normal and overweight BMI categories exhibited the lowest risk-adjusted mortality rates.
- Slightly increased mortality was observed in patients with BMI values below the high-normal range or above the overweight category.
Conclusions:
- Overall body size, as measured by BMI, is not a significant risk factor for mortality after CABG surgery.
- The lowest in-hospital mortality rates were observed in the high-normal and overweight BMI subgroups.
- Underweight and obese patients demonstrated a trend towards slightly higher mortality compared to the optimal BMI ranges.
Background:
The published articles examining obesity and CABG surgery contain conflicting results about the role of body mass index (BMI) as a risk factor for in-hospital mortality.
Methods And Results:
We studied 16 218 patients who underwent isolated CABG in the Providence Health System Cardiovascular Study Group database from 1997 to 2003. The effect of BMI on in-hospital mortality was assessed by logistic regression, with BMI group (underweight, normal, overweight, and 3 subgroups of obesity) as a categorical variable or transformations, including fractional polynomials, of BMI as a continuous variable. BMI was not a statistically significant risk factor for mortality in any of these assessments. However, using cumulative sum techniques, we found that the lowest risk-adjusted CABG in-hospital mortality was in the high-normal and that overweight BMI subgroup patients with lower or higher BMI had slightly increased mortality.
Conclusions:
Body size is not a significant risk factor for CABG mortality, but the lowest mortality is found in the high-normal and overweight subgroups compared with obese and underweight.
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