In the present series , overweight and obese patients had similar or slightly lower in-hospital mortality rates after cardiac surgery compared with normal-weight individuals .
Conversely , postoperative complication rates increased with higher BMI levels .
Most studies included in the review showed that overweight and obese patients had at least the same mortality rate as normal-weight patients , or even a lower death risk .
Pooled- data of the meta- analysis provided evidence on the association between higher BMI levels and a lower all-cause in-hospital mortality rate after cardiac surgery
The relationship between higher body mass index ( BMI ) , decreased morbidity and mortality is known as the " obesity paradox " , and has been described in cohorts of patients with hypertension , diabetes , heart failure , coronary and peripheral artery diseases , non-cardiac surgery , and end-stage renal disease .
Here we investigated the relationship between BMI and short-term outcomes after adult cardiac surgery to explore the existence of an obesity paradoxical effect .
A secondary objective was to perform an up date d systematic review to further analyze the association between BMI and 30-day in-hospital mortality after cardiac surgery .
EuroSCORE II.
OBJECTIVES To up date the European System for Cardiac Operative Risk Evaluation ( EuroSCORE ) risk model . METHODS A dedicated website collected prospect i ve risk and outcome data on 22,381 consecutive patients undergoing major cardiac surgery in 154 hospitals in 43 countries over a 12-week period ( May-July 2010 ) . Completeness and accuracy were vali date d during data collection using m and atory field entry , error and range checks and after data collection using summary feedback confirmation by responsible officers and multiple logic checks . Information was obtained on existing EuroSCORE risk factors and additional factors proven to influence risk from research conducted since the original model . The primary outcome was mortality at the base hospital . Secondary outcomes were mortality at 30 and 90 days . The data set was divided into a developmental subset for logistic regression modelling and a validation subset for model testing . A  logistic risk model ( EuroSCORE II ) was then constructed and tested . RESULTS Compared with the original 1995 EuroSCORE data base ( in brackets ) , the mean age was up at 64.7 ( 62.5 ) with 31 % females ( 28 % ) . More patients had New York Heart Association class IV , extracardiac arteriopathy , renal and pulmonary dysfunction .  Overall mortality was 3.9 % ( 4.6 % ) . When applied to the current data , the old risk models overpredicted mortality ( actual : 3.9 % ; additive predicted : 5.8 % ; logistic predicted : 7.57 % ) . EuroSCORE II was well calibrated on testing in the validation data subset of 5553 patients ( actual mortality : 4.18 % ; predicted : 3.95 % ) . Very good discrimination was maintained with an area under the receiver operating characteristic curve of 0.8095 . CONCLUSIONS Cardiac surgical mortality has significantly reduced in the last 15 years despite older and sicker patients . EuroSCORE II is better calibrated than the original model yet preserves powerful discrimination . It is proposed for the future assessment of cardiac surgical risk
In the present series , overweight and obese patients had similar or slightly lower in-hospital mortality rates after cardiac surgery compared with normal-weight individuals .
Conversely , postoperative complication rates increased with higher BMI levels .
Most studies included in the review showed that overweight and obese patients had at least the same mortality rate as normal-weight patients , or even a lower death risk .
Pooled- data of the meta- analysis provided evidence on the association between higher BMI levels and a lower all-cause in-hospital mortality rate after cardiac surgery
The relationship between higher body mass index ( BMI ) , decreased morbidity and mortality is known as the " obesity paradox " , and has been described in cohorts of patients with hypertension , diabetes , heart failure , coronary and peripheral artery diseases , non-cardiac surgery , and end-stage renal disease .
Here we investigated the relationship between BMI and short-term outcomes after adult cardiac surgery to explore the existence of an obesity paradoxical effect .
A secondary objective was to perform an up date d systematic review to further analyze the association between BMI and 30-day in-hospital mortality after cardiac surgery .