Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults: An Analysis of Data From the Society of Thoracic Surgeons Database

Michael L. O'Byrne, Sunghee Kim, Christoph P. Hornik, Babatunde A. Yerokun, Roland A. Matsouaka, Jeffrey P. Jacobs, Marshall L Jacobs, Richard A. Jonas

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated.

METHODS: A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression.

RESULTS: Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (P<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; P<0.0001), and underweight (odds ratio, 1.39; P=0.002) subjects were associated with increased risk of composite outcome.

CONCLUSIONS: Obesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.

Original languageEnglish (US)
Pages (from-to)704-718
Number of pages15
JournalCirculation
Volume136
Issue number8
DOIs
StatePublished - Aug 22 2017

Fingerprint

Thinness
Young Adult
Obesity
Databases
Mortality
Odds Ratio
Wound Infection
Thoracic Surgery
Heart Diseases
Length of Stay
Reoperation
Body Mass Index
Cohort Studies
Retrospective Studies
Logistic Models
Hemorrhage
Weights and Measures
Research

Keywords

  • cardiac surgical procedures
  • cardiology
  • mortality
  • obesity
  • outcome assessment (health care)
  • pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults : An Analysis of Data From the Society of Thoracic Surgeons Database. / O'Byrne, Michael L.; Kim, Sunghee; Hornik, Christoph P.; Yerokun, Babatunde A.; Matsouaka, Roland A.; Jacobs, Jeffrey P.; Jacobs, Marshall L; Jonas, Richard A.

In: Circulation, Vol. 136, No. 8, 22.08.2017, p. 704-718.

Research output: Contribution to journalArticle

O'Byrne, Michael L. ; Kim, Sunghee ; Hornik, Christoph P. ; Yerokun, Babatunde A. ; Matsouaka, Roland A. ; Jacobs, Jeffrey P. ; Jacobs, Marshall L ; Jonas, Richard A. / Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults : An Analysis of Data From the Society of Thoracic Surgeons Database. In: Circulation. 2017 ; Vol. 136, No. 8. pp. 704-718.
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T1 - Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults

T2 - An Analysis of Data From the Society of Thoracic Surgeons Database

AU - O'Byrne, Michael L.

AU - Kim, Sunghee

AU - Hornik, Christoph P.

AU - Yerokun, Babatunde A.

AU - Matsouaka, Roland A.

AU - Jacobs, Jeffrey P.

AU - Jacobs, Marshall L

AU - Jonas, Richard A.

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N2 - BACKGROUND: Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated.METHODS: A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression.RESULTS: Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (P<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; P<0.0001), and underweight (odds ratio, 1.39; P=0.002) subjects were associated with increased risk of composite outcome.CONCLUSIONS: Obesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.

AB - BACKGROUND: Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated.METHODS: A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression.RESULTS: Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (P<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; P<0.0001), and underweight (odds ratio, 1.39; P=0.002) subjects were associated with increased risk of composite outcome.CONCLUSIONS: Obesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.

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KW - cardiology

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KW - outcome assessment (health care)

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