Habib Robert H, Zacharias Anoar, Schwann Thomas A, Riordan Christopher J, Durham Samuel J, Shah Aamir
Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio 43608, USA.
Ann Thorac Surg. 2005 Jun;79(6):1976-86. doi: 10.1016/j.athoracsur.2004.11.029.
The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes.
Primary isolated CABG patients were grouped based on body surface area (BSA, m2) and body mass index (BMI, kg/m2) as follows: 611 very small (BSA < or = 1.70); 933 slightly small (1.70 < BSA < or = 1.85); 945 moderately obese (32 < BMI < 36); 594 very obese (BMI > or = 36); and 3,018 normal (BSA >1.85; BMI = 22 to 32). Subcohorts of very small (371 pairs, 61%), slightly small (717, 77%), moderately obese (874, 92%), and very obese (516, 87%) patients were propensity-matched to normal.
Compared with normal, very small had more transfusions (46% versus 32%; p < 0.001), reoperation for bleeding (3.2% versus 0.3%; p = 0.002), and pulmonary edema (2.4% versus 0.5%; p = 0.033). For slightly small, transfusion (41% versus 29%; p < 0.001) and bleeding (2.5% versus 1.0%; p = 0.04) were increased. For moderately obese, sternal wound infections (1.9% versus 0.8%; p = 0.04) were greater. Complications were most frequent in very obese: reoperation (5.2% versus 1.6%; p < 0.001), sternal wound infections (3.5% versus 0.2%; p < 0.001), pulmonary edema (2.9% versus 1.2%; p = 0.047), renal failure (6.0% versus 2.3%; p = 0.003), atrial fibrillation (20% versus 12%; p = 0.001), gastrointestinal problems (3.7% versus 1.6%; p = 0.032), and postoperative stay (8.0 versus 6.4 days; p = 0.003). When slightly small and very small are considered together, operative mortality was significantly greater (3.22% versus 1.65%; p = 0.026). Both very small (risk ratio [RR] = 1.39; p = 0.044) and very obese (RR = 1.44; p = 0.020) were independent predictors of worse 0- to 12-year mortality.
Large deviations from normal body size in either direction--particularly extreme obesity--are associated with increased postoperative morbidity and worse long-term survival.
体型对冠状动脉旁路移植术（CABG）手术及长期预后的影响尚未明确。我们旨在阐明小体型和肥胖对CABG预后的独立影响。
将初次单纯CABG患者根据体表面积（BSA，m²）和体重指数（BMI，kg/m²）分组如下：611例超小体型（BSA≤1.70）；933例略小体型（1.70＜BSA≤1.85）；945例中度肥胖（32＜BMI＜36）；594例极度肥胖（BMI≥36）；以及3018例正常体型（BSA＞1.85；BMI=22至32）。超小体型（371对，61%）、略小体型（717对，77%）、中度肥胖（874对，92%）和极度肥胖（516对，87%）患者的亚组与正常体型患者进行倾向匹配。
与正常体型患者相比，超小体型患者输血更多（46%对32%；p＜0.001）、因出血再次手术（3.2%对0.3%；p=0.002）以及发生肺水肿（2.4%对0.5%；p=0.033）。略小体型患者输血（41%对29%；p＜0.001）和出血（2.5%对1.0%；p=0.04）增加。中度肥胖患者胸骨伤口感染更多（1.9%对0.8%；p=0.04）。并发症在极度肥胖患者中最常见：再次手术（5.2%对1.6%；p＜0.001）、胸骨伤口感染（3.5%对0.2%；p＜0.001）、肺水肿（2.9%对1.2%；p=0.047）、肾衰竭（6.0%对2.3%；p=0.003）、心房颤动（20%对12%；p=0.001）、胃肠道问题（3.7%对1.6%；p=0.032）以及术后住院时间（8.0天对6.4天；p=0.003）。当将略小体型和超小体型患者合并考虑时，手术死亡率显著更高（3.22%对1.65%；p=0.026）。超小体型（风险比[RR]=1.39；p=0.044）和极度肥胖（RR=1.44；p=0.020）均是0至12年死亡率更差的独立预测因素。
无论体型向哪个方向偏离正常——尤其是极度肥胖——都与术后发病率增加和长期生存率降低相关。
