Kuduvalli Manoj, Grayson Antony D, Oo Aung Y, Fabri Brian M, Rashid Abbas
Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool L14 3PE, UK.
Eur J Cardiothorac Surg. 2002 Nov;22(5):787-93. doi: 10.1016/s1010-7940(02)00448-7.
Obesity is often perceived to be a risk factor for adverse outcomes following coronary artery bypass graft (CABG) surgery. Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to examine the relationship between obesity and in-hospital outcomes following CABG, while adjusting for confounding factors.
A total of 4713 consecutive patients undergoing isolated CABG between April 1997 and September 2001 were retrospectively analyzed. Body mass index (BMI) was used as the measure of obesity and was grouped as non-obese (BMI <30), obese (BMI 30-35), and severely obese (BMI > or =35). Associations between obesity and in-hospital outcomes were assessed by use of logistic regression to adjust for differences in patient characteristics.
A total of 3429 patients were defined as non-obese, compared to 1041 obese and 243 severely obese. There was no association between obesity and in-hospital mortality, stroke, myocardial infarction, re-exploration for bleeding and renal failure. Obesity was significantly associated with atrial arrhythmia (adjusted odds ratio (OR) 1.19, P = 0.037 for the obese; adjusted OR 1.52, P = 0.008 for the severely obese) and sternal wound infections (adjusted OR 1.82, P = 0.002 for the obese; adjusted OR 2.10, P = 0.038 for the severely obese). The severely obese patients were 4.17 (P < 0.001) times more likely to develop harvest site infections. Severely obese patients were also more likely to have prolonged mechanical ventilation and post-operative stays, compared to non-obese patients.
Obese patients are not associated with an increased risk of in-hospital mortality following coronary artery bypass surgery. In contrast, there is a significant increased risk of morbidities and post-operative length of stay in obese patients compared to non-obese patients.
肥胖常被视为冠状动脉旁路移植术（CABG）后不良结局的危险因素。多项研究对肥胖与不良结局风险之间的关系尚不明确。本研究的目的是在调整混杂因素的情况下，探讨肥胖与CABG术后院内结局之间的关系。
对1997年4月至2001年9月期间连续接受单纯CABG手术的4713例患者进行回顾性分析。体重指数（BMI）用作肥胖的衡量指标，分为非肥胖（BMI<30）、肥胖（BMI 30 - 35）和重度肥胖（BMI≥35）。通过逻辑回归评估肥胖与院内结局之间的关联，以调整患者特征的差异。
共有3429例患者被定义为非肥胖，1041例肥胖，243例重度肥胖。肥胖与院内死亡率、中风、心肌梗死、再次开胸止血及肾衰竭之间无关联。肥胖与房性心律失常显著相关（肥胖者调整后的优势比（OR）为1.19，P = 0.037；重度肥胖者调整后的OR为1.52，P = 0.008）以及胸骨伤口感染（肥胖者调整后的OR为1.82，P = 0.002；重度肥胖者调整后的OR为2.10，P = 0.038）。重度肥胖患者发生取血管部位感染的可能性高4.17倍（P < 0.001）。与非肥胖患者相比，重度肥胖患者也更可能需要延长机械通气时间和术后住院时间。
肥胖患者在冠状动脉旁路移植术后院内死亡风险并未增加。相反，与非肥胖患者相比，肥胖患者发生并发症及术后住院时间显著增加。
