Background: Obesity has a great impact on overall mortality and morbidity in cardiac surgery. The magnitude of obesity is defined by means of body mass index (BMI). At this study we aim to correlate between grade of BMI and postoperative complications in patients undergoing coronary revascularization. Methods: A prospective observational study was conducted in Ain Shams University hospitals and the National Heart Institute of Egypt. 98 patients with multi-vessel CAD and candidate for CABG were included in the study and divided into two groups Group I: 53 patients with BMI over 30. Group II: 45 patients with a BMI under 30. The primary endpoint was wound infection and mediastinitis. Secondary endpoints included mortality, prolonged ICU and hospital stay, stroke, renal and hepatic impairment. Results: As regard primary ending point, eight patients of Group I had their wounds infected which is significantly higher than the other group (p-value 0.034). The total ward stay in days was significantly higher in Group I (p-value 0.027). Conclusion: BMI more than 30 is associated with increased rates of wound complications either superficial or deep wound infections. Robust measures should be taken to prevent such grave complications.
References
[1]
Eagle, K.A., Guyton, R.A., Davidoff, R., Ewy, G.A., Fonger, J., Gardner, T.J., et al. (1999) ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: Executive Summary and Recommendations. Circulation, 100, 1464-1480.
https://doi.org/10.1161/01.CIR.100.13.1464
[2]
Brandt, M., Harder, K., Walluscheck, K.P., Schottler, J., Rahimi, A., Moller, F., et al. (2001) Severe Obesity Does Not Adversely Affect Perioperative Mortality and Morbidity in Coronary Artery Bypass Surgery. European Journal of Cardio-Thoracic Surgery, 19, 662-666. https://doi.org/10.1016/S1010-7940(01)00647-9
[3]
Engelman, D.T., Adams, D.H., Byrne, J.G., Aranki, S.F., Collins Jr., J.J., et al. (1999) Impact of Body Mass Index and Albumin on Morbidity and Mortality after Cardiac Surgery. The Journal of Thoracic and Cardiovascular Surgery, 118, 866-873.
https://doi.org/10.1016/S0022-5223(99)70056-5
[4]
Reeves, B.C., Ascione, R., Chamberlain, M.H. and Angelini, G.D. (2003) Effect of Body Mass Index on Early Outcomes in Patients Undergoing Coronary Artery Bypass Surgery. Journal of the American College of Cardiology, 42, 668-676.
https://doi.org/10.1016/S0735-1097(03)00777-0
[5]
Simopoulos, A.P. and Van Itallie, T.B. (1984) Body Weight, Health, and Longevity. Annals of Internal Medicine, 100, 285-295.
https://doi.org/10.7326/0003-4819-100-2-285
[6]
Ridderstolpe, L., Gill, H., Granfeldt, H., åhlfeldt, H. and Rutberg, H. (2001) Superficial and Deep Sternal Wound Complications: Incidence, Risk Factors and Mortality. European Journal of Cardio-Thoracic Surgery, 20, 1168-1175.
https://doi.org/10.1016/S1010-7940(01)00991-5
[7]
Ardeshiri, M., Faritous, Z., Haghighi, Z.O., Hosseini, S. and Baghaei, R. (2014) Effect of Obesity on Mortality and Morbidity after Coronary Artery Bypass Grafting Surgery in Iranian Patients. Anesthesiology and Pain Medicine, 4, e18884.
https://doi.org/10.5812/aapm.18884
[8]
Prabhakar, G., Haan, C.K., Peterson, E.D., Coombs, L.P., Cruzzavala, J.L. and Murray, G.F. (2002) The Risk of Moderate and Extreme Obesity for Coronary Artery Bypass Grafting Outcomes: A Study from the Society of Thoracic Surgeons’ Database. The Annals of Thoracic Surgery, 74, 1125-1131.
https://doi.org/10.1016/S0003-4975(02)03899-7
[9]
Engel, A.M., McDonough, S. and Smith, J.M. (2009) Does an Obese Body Mass Index Affect Hospital Outcomes after Coronary Artery Bypass Graft Surgery? The Annals of Thoracic Surgery, 88, 1793-1800.
https://doi.org/10.1016/j.athoracsur.2009.07.077
[10]
Abdallah, A.G., Elnewihy, M.A., Brik, A.I. and Salem, A.M.M. (2017) Impact of Obesity on Early Cardiac Surgical Outcomes in Egypt: Early Outcomes of Coronary Artery Bypass Graft Surgery. Journal of the Egyptian Society of Cardio-Thoracic Surgery, 25, 192-197. https://doi.org/10.1016/j.jescts.2017.08.001
[11]
Tokmakoglu, H. (2010) Operative and Early Results of Coronary Artery Bypass Grafting in Female Patients in Different Body Mass Indexes. Journal of Cardiothoracic Surgery, 5, 119. https://doi.org/10.1186/1749-8090-5-119
[12]
Herishanu, Y., Rogowski, O., Polliack, A. and Marilus, R. (2006) Leukocytosis in Obese Individuals: Possible Link in Patients with Unexplained Persistent Neutrophilia. European Journal of Haematology, 76, 516-520.
https://doi.org/10.1111/j.1600-0609.2006.00658.x
[13]
Oreopoulos, A., Padwal, R., Norris, C.M., Mullen, J.C., Pretorius, V. and Kalantar-Zadeh, K. (2008) Effect of Obesity on Short- and Long-Term Mortality Postocoronary Revascularization: A Meta Analysis. Obesity, 16, 442-450.
https://doi.org/10.1038/oby.2007.36
[14]
Kuduvalli, M., Grayson, A.D., Oo, A.Y., Fabri, B.M. and Rashid, A. (2002) Risk of Morbidity and In-Hospital Mortality in Obese Patients Undergoing Coronary Artery Bypass Surgery. European Journal of Cardio-Thoracic Surgery, 22, 787-793.
https://doi.org/10.1016/S1010-7940(02)00448-7
[15]
Ray, C.S., Sue, D.Y., Bray, G., Hansen, J.E. and Wasserman, K. (1983) Effects of Obesity on Respiratory Function. American Review of Respiratory Disease, 128, 501-506. https://doi.org/10.1164/arrd.1983.128.3.501
[16]
Wang, T.K.M., Ramanathan, T., Stewart, R., Gamble, G. and White, H. (2013) Lack of Relationship between Obesity and Mortality or Morbidity after Coronary Artery Bypass Grafting. The New Zealand Medical Journal, 126, 56-65.
[17]
Yap, C.H., Zimmet, A., Mohajeri, M. and Yii, M. (2007) Effect of Obesity on Early Morbidity and Mortality Following Cardiac Surgery. Heart, Lung and Circulation, 16, 31-36. https://doi.org/10.1016/j.hlc.2006.09.007
[18]
Abd Al Jawad, M.N. (2016) Proposed Model for Reducing Deep Sternal Wound Infection in Overweight Patients Undergoing Coronary Bypass Grafting: Strategies and Tricks. Ain Shams Medical Journal, 67, 511-518.
