Post-CABG hospital stays longer in severely obese patients
By Laura Cowen
Severely obese patients have longer hospital stays after coronary artery bypass grafting than patients with normal body mass index (BMI), which may be due to their increased infection risk, Canadian researchers report.
“With increases in the demand for cardiac surgical interventions among patients with severe obesity, this information should be useful to caregivers, surgeons, and their patients to assess the risks and clinical outcomes and to better prepare for possible adverse outcomes, perhaps leading to better resource use”, say Mary Forhan (University of Alberta, Edmonton) and colleagues.
The researchers found no significant differences in postoperative mortality between the patients with normal BMI (18.5-24.9 kg/m2, n=1509) and those classified as overweight (25.0-29.9 kg/m2, n=3080) or obese class I (30.0-34.9 kg/m2, n=1942), II (35.0-39.9 kg/m2, n=696) or III (?40.0 kg/m2, n=333).
However, obese class II and III patients were significantly more likely to experience postoperative complications than patients with normal BMI, with odds ratios of 1.35 and 1.56, respectively, after adjustment for baseline differences including age and comorbidity.
Of the individual postoperative complications analysed, infection was a significant 1.60, 2.34 and 3.29 times more common among obese classes I, II and III patients, respectively, than among those with normal BMI.
By contrast, the risks of renal and pulmonary complications were not different between any of the BMI groups.
Forhan and team also found that obese class III patients had a median hospital of 7 days, which was significantly longer than the 6-day median stay reported for patients with normal BMI.
“We speculate that higher rates of infection in the obese class III group contributed to prolonged LOS [length of stay]”, the authors write in the Journal of the American Heart Association.
Furthermore, stepwise multiple regression analysis of the obese class III group showed that infection, dialysis, renal complications, ejection fraction below 20% and female gender were associated with longer hospital stays.
And patients with diabetes and infection stayed in hospital 3.2 times longer than those with no diabetes or infection (19 vs 6 days).
Forhan et al conclude: “Concerted efforts to reduce the incidence of infection and perioperative blood glucose are likely to be effective in reducing prolonged LOS and associated costs.”
J Am Heart Assoc 2016; Advance online publication
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