Obesity and coronary artery surgery

Objective. To assess whether obesity is a risk factor for morbidity and mor tality in patients undergoing elective coronary artery revascularization. Design: Prospective, clinical study. Setting: University hospital. Participants. Three hundred forty-five consecutive patients who underwent e lective coronary revascularization with cardiopulmonary bypass and without associated procedures. Interventions: Patients were assigned to the obese group if their body mass index-was greater than 30 for men and 28.6 for women, according td the Wor ld Health Organization indications. Measurements and Main Results: Preoperative and intraoperative variables we re collected and checked for homogeneity of the groups. Postoperative outco me was assessed on the basis of intubation time, intensive care unit (ICU) and postoperative hospital stay, mortality rate, and incidence of transfusi ons, reoperations, low-output syndrome, minor and major neurologic dysfunct ion, minor and major lung dysfunctions, renal dysfunction,and superficial a nd deep infections. The effect of obesity on postoperative outcome was test ed with a multivariate logistic regression analysis. Obese and control pati ents had the same intubation time and ICU and postoperative hospital stay. Mortality and all major complications occurred with the same incidence in t he two groups. Obese patients had a significantly (p < 0.05) greater rate o f superficial infections and more (24.1% v 7.4%; p < 0.001) minor lung comp lications. Conversely, they had a significantly lower transfusion rate (27. 5% v 42.7%; p < 0.01). Conclusion: Obese patients had only minor complications after coronary arte ry surgery. The large body surface area because of obesity protects them ag ainst the hemodilution-related transfusion risk. Copyright (C) 1999 by W.B. Saunders Company.