Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 8;6(3):e003831.
doi: 10.1161/JAHA.116.003831.

Obesity Increases Risk-Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery

Ravi K Ghanta  1 , Damien J LaPar  2 , Qianzi Zhang  3 , Vishal Devarkonda  2 , James M Isbell  2 , Leora T Yarboro  2 , John A Kern  2 , Irving L Kron  2 , Alan M Speir  4 , Clifford E Fonner  5 , Gorav Ailawadi  2
Affiliations

Obesity Increases Risk-Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery

Ravi K Ghanta et al. J Am Heart Assoc. .

Abstract

Background: Despite the epidemic rise in obesity, few studies have evaluated the effect of obesity on cost following cardiac surgery. We hypothesized that increasing body mass index (BMI) is associated with worse risk-adjusted outcomes and higher cost.

Methods and results: Medical records for 13 637 consecutive patients who underwent coronary artery bypass grafting (9702), aortic (1535) or mitral (837) valve surgery, and combined valve-coronary artery bypass grafting (1663) procedures were extracted from a regional Society of Thoracic Surgeons certified database. Patients were stratified by BMI: normal to overweight (BMI 18.5-30), obese (BMI 30-40), and morbidly obese (BMI >40). Differences in outcomes and cost were compared between BMI strata and also modeled as a continuous function of BMI with adjustment for preoperative risk using Society of Thoracic Surgeons predictive risk indices. Morbidly obese patients incurred nearly 60% greater observed mortality than normal weight patients. Moreover, morbidly obese patients had greater than 2-fold increase in renal failure and 6.5-fold increase in deep sternal wound infection. After risk adjustment, a significant association was found between BMI and mortality (P<0.001) and major morbidity (P<0.001). The risk-adjusted odds ratio for mortality for morbidly obese patients was 1.57 (P=0.02) compared to normal patients. Importantly, risk-adjusted total hospital cost increased with BMI, with 17.2% higher costs in morbidly obese patients.

Conclusions: Higher BMI is associated with increased mortality, major morbidity, and cost for hospital care. As such, BMI should be more strongly considered in risk assessment and resource allocation.

Keywords: complication; cost; obesity; surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Risk‐adjusted major morbidity by BMI (body mass index).
Figure 2
Figure 2
Risk‐adjusted mortality by BMI (body mass index).
Figure 3
Figure 3
Total hospital cost by BMI (body mass index).
See this image and copyright information in PMC

References

    1. McLellan F. Obesity rising to alarming levels around the world. Lancet. 2002;359:1412. - PubMed
    1. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard‐Barbash R, Hollenbeck A, Leitzmann MF. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355:763–778. - PubMed
    1. Chen Z, Yang G, Offer A, Zhou M, Smith M, Peto R, Ge H, Yang L, Whitlock G. Body mass index and mortality in China: a 15‐year prospective study of 220 000 men. Int J Epidemiol. 2012;41:472–481. - PubMed
    1. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, He J, Gupta PC, Ramadas K, Tsugane S, Irie F, Tamakoshi A, Gao YT, Wang R, Shu XO, Tsuji I, Kuriyama S, Tanaka H, Satoh H, Chen CJ, Yuan JM, Yoo KY, Ahsan H, Pan WH, Gu D, Pednekar MS, Sauvaget C, Sasazuki S, Sairenchi T, Yang G, Xiang YB, Nagai M, Suzuki T, Nishino Y, You SL, Koh WP, Park SK, Chen Y, Shen CY, Thornquist M, Feng Z, Kang D, Boffetta P, Potter JD. Association between body‐mass index and risk of death in more than 1 million Asians. N Engl J Med. 2011;364:719–729. - PMC - PubMed
    1. Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton‐Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman‐Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch‐Jacquotte A, Willett WC, Thun MJ. Body‐mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–2219. - PMC - PubMed

MeSH terms