• Mei Gao, Jianzhong Sun, Nilas Young, Douglas Boyd, Zane Atkins, Zhongmin Li, Qian Ding, James Diehl, and Hong Liu.
• Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA.
• J. Cardiothorac. Vasc. Anesth. 2016 Oct 1; 30 (5): 1308-16.

ObjectivesBody mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery.DesignA retrospective cohort study.SettingUniversity teaching hospital, 2 centers.ParticipantsThe study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from July 1, 2001, to June 30, 2013, in 1 hospital and from September 1, 2003, to August 31, 2014, in a second hospital.InterventionsNo changes to standard practice were required.Measurements And Main ResultsPatients were assigned into 6 BMI groups as follows: underweight (BMI<18.5 kg/m(2)), normal weight (≥18.5 to<25 kg/m(2)), overweight (≥25 to<30 kg/m(2)), class I obese (≥30 to<35 kg/m(2)), class II obese (≥35 to<40 kg/m(2)), and class III obese (BMI≥40 kg/m(2)). Short-term major postoperative complications (postoperative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, intensive care unit readmission, total intensive care unit hours, and readmission in 30 days, and mortalities (in-hospital mortality, 30-day mortality, surgical mortality) were compared among various BMI groups after cardiac surgery. Age, sex, surgery type, family history of coronary artery disease, diabetes, hypertension, heart failure, and lipid-lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that the underweight and class III obese BMI groups demonstrated significant, adverse differences in some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter, and renal failure. However, being in the overweight or class I obese group demonstrated a positive effect on discharge and surgical mortality.ConclusionsThe results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an "obese paradox" in short-term mortality after cardiac surgery.Copyright © 2016 Elsevier Inc. All rights reserved.

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