Obesity and the risk of early and late mortality after coronary artery bypass graft surgery


Kim, J; Hammar, N; Jakobsson, K; Luepker, RV; McGovern, PG; Ivert, T; (2003) Obesity and the risk of early and late mortality after coronary artery bypass graft surgery. American heart journal, 146 (3). pp. 555-60. ISSN 0002-8703 DOI: https://doi.org/10.1016/S0002-8703(03)00185-6

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Abstract

BACKGROUND: Obesity is often considered to be a significant risk factor for postoperative mortality when selecting candidates for coronary artery bypass grafting (CABG). METHODS: We included all patients undergoing a first isolated CABG at the Karolinska Hospital in Stockholm, Sweden, between 1980 and 1995 (n = 6728). Patients were categorized on the basis of body mass index (BMI): non-overweight (BMI <25 kg/m2), overweight (25 kg/m2 < or = BMI <30 kg/m2), and obese (BMI > or =30 kg/m2). Multivariate Cox regression was used to assess the risk of re-operation for bleeding, deep sternal wound infection, and early (< or =30 days) and late (< or =5 years) mortality rates. RESULTS: The average length of follow-up was 6.5 years. There were 252 re-operations for bleeding, 53 deep sternal wound infections, and 628 deaths. Patients who were obese had a significantly lower risk of re-operation for bleeding (risk ratio [RR], 0.32; 95% CI, 0.19-0.53), but a greater risk of deep sternal wound infection (RR, 2.66; 95% CI, 1.21-5.88) compared with patients who were not overweight. However, patients who were obese and patients who were not overweight experienced similar 30-day (RR, 0.65; 95% CI, 0.34-1.27), 1-year (RR, 0.56; 95% CI, 0.29-1.10), and 5-year mortality rates (RR, 0.91; 95% CI, 0.66-1.25). Results for patients who were overweight were consistent with those of patients who were obese. CONCLUSION: Patients who are obese are not at a greater risk of early and late mortality after CABG compared with patients who are not overweight, although they appear to have a lower risk of re-operation for bleeding and a greater risk of deep sternal wound infection. Therefore, obesity per se is not a contraindication for CABG.

Item Type: Article
Keywords: Angina Pectoris/complications/mortality/*surgery, Body Mass Index, Coronary Artery Bypass/*mortality, Human, Middle Aged, Obesity/complications/*mortality, Postoperative Hemorrhage/etiology, Prognosis, Reoperation, Risk Factors, Statistics, Sternum/surgery, Support, Non-U.S. Gov't, Surgical Wound Infection/etiology, Time Factors, Angina Pectoris, complications, mortality, surgery, Body Mass Index, Coronary Artery Bypass, mortality, Human, Middle Aged, Obesity, complications, mortality, Postoperative Hemorrhage, etiology, Prognosis, Reoperation, Risk Factors, Statistics, Sternum, surgery, Support, Non-U.S. Gov't, Surgical Wound Infection, etiology, Time Factors
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 12947378
Web of Science ID: 185352800029
URI: http://researchonline.lshtm.ac.uk/id/eprint/15079

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