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Ann Thorac Surg 2005;79:1976-1986
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched Analysis

^a Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio
^b Division of Cardiovascular Surgery, St. Luke’s Hospital, Maumee, Ohio
^c Department of Medicine, Medical College of Ohio, Toledo, Ohio
^d Department of Surgery, Medical College of Ohio, Toledo, Ohio

Accepted for publication November 17, 2004.

^_* Address reprint requests to Dr Habib, Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry St, ACC Bldg, Suite 309, Toledo, OH43608 (E-mail: robert_habib{at}mhsnr.org).

BACKGROUND: The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes.

METHODS: Primary isolated CABG patients were grouped based on body surface area (BSA, m²) and body mass index (BMI, kg/m²) as follows: 611 very small (BSA 1.70); 933 slightly small (1.70 < BSA 1.85); 945 moderately obese (32 < BMI <36); 594 very obese (BMI 36); and 3,018 normal (BSA >1.85; BMI = 22 to 32). Subcohorts of very small (371 pairs, 61%), slightly small (717, 77%), moderately obese (874, 92%), and very obese (516, 87%) patients were propensity-matched to normal.

RESULTS: Compared with normal, very small had more transfusions (46% versus 32%; p < 0.001), reoperation for bleeding (3.2% versus 0.3%; p = 0.002), and pulmonary edema (2.4% versus 0.5%; p = 0.033). For slightly small, transfusion (41% versus 29%; p < 0.001) and bleeding (2.5% versus 1.0%; p = 0.04) were increased. For moderately obese, sternal wound infections (1.9% versus 0.8%; p = 0.04) were greater. Complications were most frequent in very obese: reoperation (5.2% versus 1.6%; p < 0.001), sternal wound infections (3.5% versus 0.2%; p < 0.001), pulmonary edema (2.9% versus 1.2%; p = 0.047), renal failure (6.0% versus 2.3%; p = 0.003), atrial fibrillation (20% versus 12%; p = 0.001), gastrointestinal problems (3.7% versus 1.6%; p = 0.032), and postoperative stay (8.0 versus 6.4 days; p = 0.003). When slightly small and very small are considered together, operative mortality was significantly greater (3.22% versus 1.65%; p = 0.026). Both very small (risk ratio [RR] = 1.39; p = 0.044) and very obese (RR = 1.44; p = 0.020) were independent predictors of worse 0- to 12-year mortality.

CONCLUSIONS: Large deviations from normal body size in either direction—particularly extreme obesity—are associated with increased postoperative morbidity and worse long-term survival.

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