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  • Title: Cardiac surgery in patients with body mass index of 50 or greater.
    Author: Villavicencio MA, Sundt TM, Daly RC, Dearani JA, McGregor CG, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV.
    Journal: Ann Thorac Surg; 2007 Apr; 83(4):1403-11. PubMed ID: 17383347.
    Abstract:
    BACKGROUND: The seemingly inexorable rise in obesity worldwide is creating a new set of challenges for healthcare providers. Demand for cardiac surgical intervention among patients at extreme levels of obesity (body mass index [BMI] > or = 50) is increasing; however, the risks, benefits, and resources required to meet this need have not been established. METHODS: Between 1993 and 2004, 57 patients with a BMI of 50 or more underwent cardiac surgical procedures at our institution. The mean BMI was 54 +/- 4, weight range was 124 to 226 kg. The mean age of the study group was 55 +/- 12 years, and comorbidities included diabetes mellitus in 29 (51%), hypertension in 40 (70%), hyperlipidemia in 22 (39%), and obstructive sleep apnea in 16 (28%). RESULTS: The operative mortality was 7% (4 patients). Eleven patients (20%) required prolonged intubation (more than 24 hours), and mean intensive care unit stay was 5 +/- 9 days. Wound complications requiring surgery occurred in 3 (5%). Survival at 1 and 5 years was 93% +/- 4% and 76 +/- 8%, respectively. By univariate analysis, age and endocarditis were associated with long-term mortality and major perioperative complications. As a dichotomous variable, BMI greater than 54 was a significant predictor of renal failure and prolonged mechanical ventilation. CONCLUSIONS: Cardiac surgery in the patient with a BMI of 50 or greater is associated with significant resource utilization, including prolonged intensive care unit and hospital stay, with prolonged intubation and wound complications relatively common.
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