ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
Obesity is still a risk factor in coronary artery bypass surgery [Anatol J Cardiol]
Anatol J Cardiol. 2014; 14(7): 631-637 | DOI: 10.5152/akd.2014.4954

Obesity is still a risk factor in coronary artery bypass surgery

Hasan Alper Gürbüz1, Ahmet Barış Durukan1, Nevriye Salman2, Halil İbrahim Uçar1, Cem Yorgancıoğlu1
1Clinic of Cardiovascular Surgery, Medicana International Ankara Hospital; Ankara-Turkey
2Clinic of Anesthesia, Medicana International Ankara Hospital; Ankara-Turkey

Objective: Even with the improvements in surgical techniques and perioperative care, obesity is still a risk factor for occurrence of adverse events following cardiac surgery. In this observational, retrospective study, we aimed to document the effects of obesity on surgical outcomes in patients undergoing coronary artery bypass surgery and find out the effects of improvements in cardiac surgery. Methods: Between January 2011 and March 2013, isolated coronary artery bypass surgery was performed on 790 patients. The body mass index values of the patients were calculated and patients were divided into two groups; below 30 were classified as non-obese group whereas above 30 were classified as obese group. The odds ratio was obtained by using univariate analysis in order to document the effects of obesity on outcomes. Results: There were 548 (69.3%) patients in non-obese group, whereas 242 (30.7%) patients in obese group. The cardiopulmonary bypass (80.47±23.58 vs. 80.89±28.46, p=0.449) and aortic clamp times (54.13±16.60 vs. 54.19±19.85, p=0.511) and number of bypass grafts (3.09±1.02 vs. 2.96±1.00, p=0.11) were comparable between the groups. The mean number of fresh frozen plasma used was higher in obese patients (1.37±1.75 vs. 1.48±4.63, p=0.02). Intubation time was higher in obese patients (10.57±6.87 vs. 12.71±35.31, p=0.014). Total amount of postoperative drainage was higher in non-obese patients (766.77±472.27 vs. 648.72±371.39, p<0.001). The superficial infection/mediastenitis (0.4% vs. 2.5%, p=0.012), dehiscence (0.2% vs. 3.7%, p<0.001) and postoperative renal failure rates (4.7% vs. 8.7%, p=0.031) were higher in obese patients. The incidence of atrial fibrillation was lower in obese patients (19.7% vs. 12.8%, p=0.019). The mortality (0.5% vs. 1.7%, p=0.210) and postoperative stroke rates (1.1% vs. 0.8%, p=1.000) were similar in both groups. Conclusion: We documented that obesity is still a risk factor for occurrence of postoperative adverse events. We believe that improved perioperative care together with meticulous regimens can improve postoperative outcomes in patients undergoing coronary artery bypass surgery.

Keywords: obesity, cardiac surgical procedures, outcome assessment (health care)

Obezite koroner arter baypas cerrahisinde halen bir risk faktörüdür

Hasan Alper Gürbüz1, Ahmet Barış Durukan1, Nevriye Salman2, Halil İbrahim Uçar1, Cem Yorgancıoğlu1
1Clinic of Cardiovascular Surgery, Medicana International Ankara Hospital; Ankara-Turkey
2Clinic of Anesthesia, Medicana International Ankara Hospital; Ankara-Turkey

Amaç: Cerrahi teknikler ve perioperatif bakımdaki gelişmelere rağmen obezite halen kalp cerrahisi sonrası istenmeyen olayların gelişimi için risk faktörüdür. Biz bu gözlemsel, retrospektif çalışmada koroner baypas cerrahisi uygulanan hastalarda obezitenin cerrahi sonuçlara etkisini göstermeyi ve kalp cerrahisindeki gelişmelerin etkisini görmeyi amaçladık. Yöntemler: Ocak 2011 ve Mart 2013 tarihleri arasında 790 hastaya izole koroner arter baypas cerrahisi uygulandı. Bu hastaların vücut kitle indeksi değerleri hesaplanarak, hastalar iki gruba ayrıldı; 30’un altında olanlar obez olmayan grup, 30’un üstünde olanlar obez grup olarak adlandırıldı. Obezitenin sonuçlar üzerine etkisini araştırmak için tek değişkenli analiz kullanılarak göreceli olasılıklar oranı hesaplandı. Bulgular: Obez olmayan grupta 548 (% 69.3), obez grupta ise 242 (% 30.7) hasta vardı. Hastaların kardiyopulmoner baypas (80.47 ± 23.58;. 80.89 ± 28.46, p: 0.449) ve aort klemp süreleri (54.13 ± 16.60; 54.19 ± 19.85, p: 0.511) ve ortalama baypas greft sayıları (3.09 ± 1.02; 2.96 ± 1.00, p: 0.11) benzerdi. Obez hastalarda kullanılan taze donmuş plazma sayısı (1.37 ± 1.75; 1.48 ± 4.63, p: 0.02) daha fazla idi. Entübasyon süresi (10.57 ± 6.87; 12.71 ± 35.31, p: 0.014) obez hasta grubunda daha yüksek idi. Postoperatif kanama miktarı obez olmayan grupta daha fazla idi (766.77 ± 472.27; 648.72 ± 371.39, p<0.001). Yüzeyel enfeksiyon/mediastenit (%0.4; %2.5, p: 012), dehisens (%0.2; %3.7, p<0.001) ve postoperatif böbrek yetmezliği (%4.7; %8.7, p: 0.031) oranları obez grupta daha yüksek idi. Postoperatif atriyal fibrilasyon oranı (%19.7; %12.8, p: 0.019) obez grupta daha düşük idi. Mortalite (%0.5; %1.7%, p: 0.210) ve postoperatif inme (%1.1; %0.8, p: 1.000) oranları her iki grupta benzer idi. Sonuç: Biz postoperatif istenmeyen olayların gelişiminde obezitenin bir risk faktörü olduğunu gösterdik. İyileştirilmiş perioperatif bakım ve titiz stratejilerle koroner arter baypas cerrahisi uygulanan hastalarda postoperatif sonuçların daha iyi olacağını düşünüyoruz.

Anahtar Kelimeler: Obezite; cerrahi girişimler, kardiyak; sonuç değerlendirmesi (sağlık hizmeti)

Hasan Alper Gürbüz, Ahmet Barış Durukan, Nevriye Salman, Halil İbrahim Uçar, Cem Yorgancıoğlu. Obesity is still a risk factor in coronary artery bypass surgery. Anatol J Cardiol. 2014; 14(7): 631-637
Manuscript Language: English


Journal Metrics

Journal Citation Indicator: 0.18
CiteScore: 1.1
Source Normalized Impact
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SCImago Journal Rank: 0.348

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