• Michael L O'Byrne, Sunghee Kim, Christoph P Hornik, Babatunde A Yerokun, Roland A Matsouaka, Jeffrey P Jacobs, Marshall L Jacobs, and Richard A Jonas.
• From Division of Cardiology, Children's National Health System, Department of Pediatrics (M.L.O.), and Division of Cardiothoracic Surgery, Children's National Health System, Department of Surgery (R.A.J.), George Washington University of Health Sciences, Washington, DC; Duke Clinical Research Institute (S.K., C.P.H., B.A.Y., R.A.M.) and Department of Pediatrics (C.P.H.), Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins University School of Medicine, St. Petersburg, FL (J.P.J.); and Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (M.L.J.). obyrnem@email.chop.edu.
• Circulation. 2017 Aug 22; 136 (8): 704-718.

BackgroundExtreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated.MethodsA multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression.ResultsOf 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (P=0.04) and composite outcome (P<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28; P=0.008), severely underweight (odds ratio, 1.29; P<0.0001), and underweight (odds ratio, 1.39; P=0.002) subjects were associated with increased risk of composite outcome.ConclusionsObesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.© 2017 American Heart Association, Inc.

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