Periprocedural Risk Predictors and Body Mass Index Impact Long-Term Prognosis in Patients Undergoing Coronary Artery Bypass Grafting

Dokollari A, Sicouri S, Kjelstrom S, Montone G, Cameli M, Yoshi Y, Gemelli M, Hassanabad AF, Ghorpade N, Cabrucci F, Bacchi B, Bonacchi M, Ramlawi B, Wertan MA and Sutter FP

1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA Department of Cardiology, University of Siena, Italy Department of Cardiac Surgery, University of Padua, Italy Department of Cardiac Surgery, Cumming School for Medical Research; University of Calgary, Canada Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Canada 8Department of Clinical and Experimental, University of Florence, Florence, Italy

^*Correspondance to: Aleksander Dokollari 

 PDF  Full Text DOI: 10.25107/2474-1647.3672

Abstract

Objective: The main goal of this study is to identify risk predictors for all-cause mortality in patients undergoing Coronary Artery Bypass Grafting (CABG) based on Body Mass Index (BMI). Methods: All consecutive 4,871 patients undergoing isolated CABG between 2005 and 2021, were included in the study. Underweight (<19 kg/m2) (n=42), normal/obese (BMI= 19-39.9 kg/m2) (n=4,622), and morbidly obese (BMI ≥ 40 kg/m2) (n=215) patients were compared for preoperative characteristics. A propensity-adjusted analysis was used to compare the groups. Primary outcome were long-term incidence of death and Major Adverse Cardiovascular and Cerebrovascular Events (MACCE). Results: Preoperatively, mean age was 71.2 (normal/obese), vs. 75.5 (underweight) vs. 65.9 (morbidly obese) years old. Intraoperatively, morbidly obese patients had higher operating room time. Postoperatively, morbidly obese, and underweight patients had higher blood product transfusion and 30-day readmission rate. Primary outcome of all-cause mortality was normal/obese 528/4622 (11.3%) vs. underweight 11/42 (26.2%) vs. morbidly obese 32/215 (14.9%), p=0.003. MACCE was significantly higher in morbidly obese patients 17/215 (7.9%), p=0.024. Predictors for all-cause mortality in morbidly obese patients were non-white patients, diabetes, Peripheral Vascular Disease (PVD), STS ≥ 4%, dialysis, hypertension, Chronic Obstructive Pulmonary Disease (COPD), Ejection Fraction (EF) <50%, and Atrial fibrillation (Afib). Predictors for all-cause mortality in underweight patients were male gender, white race, STS ≥ 4%, dialysis, EF<50%, and hypertension. Conclusion: Death rate in underweight patients was two-fold compared to normal/obese patients and 57% higher compared to morbidly obese patients. MACCE rate was significantly higher in morbidly obese patients.

Keywords

Obesity; BMI; Underweight; CABG; Risk Factors: Long-Term Prognosis

Cite the article

Dokollari A, Sicouri S, Kjelstrom S, Montone G, Cameli M, Yoshi Y, et al. Periprocedural Risk Predictors and Body Mass Index Impact Long-Term Prognosis in Patients Undergoing Coronary Artery Bypass Grafting. Clin Surg. 2023; 8: 3672..