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Published on: November 10, 2018
Increasing obesity is associated with lower postoperative bleeding in coronary bypass patients
Rajesh Bhavsar1, Mariann Tang1, Jacob Greisen1
1Heart, Lung, and Vascular, Aarhus University Hospital, Aarhus, Denmark.
Insights
Obese cardiac surgery patients experience less bleeding and fewer transfusions. Underweight patients face higher bleeding risks and worse outcomes, suggesting obesity may offer protection against postoperative bleeding.
Area of Science:
- Cardiovascular Surgery
- Obesity Research
- Hemostasis and Thrombosis
Background:
- Obesity is often linked to increased surgical risks, yet some studies suggest a paradoxical protective effect in cardiac surgery.
- The mechanisms behind this association, particularly concerning bleeding and transfusion needs, remain unclear.
Purpose of the Study:
- To investigate the impact of body mass index (BMI) on short- and long-term postoperative outcomes in coronary bypass grafting (CABG) patients.
- Specifically focusing on bleeding complications and red blood cell transfusion requirements.
Main Methods:
- Retrospective analysis of 12,330 coronary bypass grafting patients from 2007-2020, using data from the Western Denmark Heart Registry.
- Assessment of the association between BMI categories and postoperative drainage, transfusion rates, reoperations, and mortality.
Main Results:
- Severely obese patients (BMI ≥40 kg/m²) had significantly less postoperative drainage (427 mL) compared to underweight patients (BMI <18.5 kg/m²) (637 mL).
- Underweight patients required red blood cell transfusions more frequently (50.0%) and in higher volumes than severely obese patients (16.7%).
- Obese groups had fewer reoperations for bleeding and required less perioperative support; however, BMI did not independently impact mortality in logistic regression.
Conclusions:
- Higher BMI may confer protection against postoperative bleeding in cardiac surgery, potentially due to a hypercoagulable state.
- Underweight patients are at increased risk for bleeding complications and poorer outcomes following cardiac surgery.
Objective:
Despite inherent comorbidities, obese cardiac surgical patients paradoxically had shown lower morbidity and mortality, although the nature of this association is still unclear. Thus, the authors intended in this large registry-based study to investigate the impact of obesity on short- and long-term postoperative outcomes, focusing on bleeding and transfusion requirements.
Design:
Retrospective registry study.
Setting:
Three university hospitals.
Participants:
A cohort of 12,330 prospectively compiled data from coronary bypass grafting patients undergoing surgery between 2007 to 2020 were retrieved from the Western 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 severely obese patients with BMI ≥40 kg/m2 (p < 0.0001, Kruskal-Wallis). Further, 50.0% of patients with BMI <18.5 received an average of 451 mL/m2 in red blood cell transfusions, compared to 16.7% of patients with BMI >40 receiving 84 mL/m2. The obese groups were less often submitted to reexploration 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, whereas 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 protection against postoperative bleeding after cardiac surgery, probably secondary to an inherent hypercoagulable state, whereas underweight patients carry a higher risk of bleeding and worse outcomes.
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