• Rajesh Bhavsar, Mariann Tang, Jacob Greisen, and Carl-Johan Jakobsen.
• Heart, Lung, and Vascular, Aarhus University Hospital, Aarhus, Denmark.
• J. Cardiothorac. Vasc. Anesth. 2023 Jul 1; 37 (7): 112911371129-1137.

ObjectiveDespite inherent comorbidities, obese cardiac surgical patients paradoxically had shown lower morbidity and mortality, although the nature of this association is still unclear. Thus, the authors intended in this large registry-based study to investigate the impact of obesity on short- and long-term postoperative outcomes, focusing on bleeding and transfusion requirements.DesignRetrospective registry study.SettingThree university hospitals.ParticipantsA cohort of 12,330 prospectively compiled data from coronary bypass grafting patients undergoing surgery between 2007 to 2020 were retrieved from the Western Denmark Heart Registry.InterventionsThe parameters were analyzed to assess the association between body mass index (BMI) and the selected outcome parameters.Measurements And Main ResultsThe crude data showed a clear statistically significant association in postoperative drainage from 637 (418-1108) mL in underweight patients with BMI <18.5 kg/m2 to 427 (295-620) mL in severely obese patients with BMI ≥40 kg/m2 (p < 0.0001, Kruskal-Wallis). Further, 50.0% of patients with BMI <18.5 received an average of 451 mL/m2 in red blood cell transfusions, compared to 16.7% of patients with BMI >40 receiving 84 mL/m2. The obese groups were less often submitted to reexploration due to bleeding, and fewer received perioperative hemostatics, inotropes, and vasoconstrictors. The crude data showed increasing 30-day and 6-month mortality with lower BMI, whereas the one-year mortality showed a V-shaped pattern, but BMI had no independent impact on mortality in logistic regression analysis.ConclusionPatients with high BMI may carry protection against postoperative bleeding after cardiac surgery, probably secondary to an inherent hypercoagulable state, whereas underweight patients carry a higher risk of bleeding and worse outcomes.Copyright © 2023 Elsevier Inc. All rights reserved.

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