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 .
Risk factors for mediastinitis following cardiac surgery: the importance of managing obesity.
BACKGROUND Mediastinitis is a devastating complication of cardiac surgery . Previous studies have often observed small population s , been retrospective in design , and used a variety of definitions for mediastinitis . AIM To identify risk factors for mediastinitis , and strategies to minimize its incidence . METHODS A prospect i ve cohort study of 4883 adult patients who underwent cardiac surgery between October 2003 and February 2009 , comparing pre- and peri-operative risk factors , microbial aetiology , requirement for re-admission , length of stay and mortality between patients with and without mediastinitis . FINDINGS Ninety ( 1.8 % ) patients were diagnosed with mediastinitis . Microbial aetiology was defined for 75 patients . Staphlyocococcus aureus was the most common isolate ( 30 episodes ; 15 due to meticillin-resistant S. aureus ) . Univariate analysis revealed the following pre-operative factors associated with mediastinitis : age ; body mass index ; diabetes ; modified logistic European System for Cardiac Operative Risk Evaluation score ; urgent admission ; and longer pre-operative stay ( P < 0.05 ) . Associated peri-operative factors were : combined coronary artery bypass grafting plus aortic valve replacement ; longer aortic cross-clamp time ; and longer cardiopulmonary bypass time ( P < 0.005 ) . Multi-variate analysis revealed that higher body mass index , combined coronary artery bypass grafting plus aortic valve replacement , and older age were associated with mediastinitis ( P < 0.05 ) . Mediastinitis was associated with re-admission to hospital , longer inpatient stay and reduced long-term survival ( P < 0.05 ) . CONCLUSION Mediastinitis is associated with worse short-term outcomes ( re-admission , length of stay ) and reduced long-term survival . Obesity is the only modifiable pre-operative risk factor for mediastinitis . It may be possible to reduce risk through pre-operative weight loss programmes before elective surgery
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 .