Tokmakoglu Hilmi
Cardiovascular Surgery Department, Ozel Tekden Hastanesi Kocasinan-Kayseri, Turkey.
J Cardiothorac Surg. 2010 Nov 26;5:119. doi: 10.1186/1749-8090-5-119.
Female gender has been reported to be an independent risk factor for coronary artery bypass grafting (CABG) in European System for Cardiac Risk Evaluation. The effect of the body size on the CABG outcome is less clear. There is ongoing debate about obesity as a risk factor for adverse outcomes after cardiovascular procedures. The goal of this retrospective study is to evaluate the in hospital and early postoperative outcomes in severe obese, obese and normal-slightly obese female patients after CABG.
In a four year period a total of 427 female patients underwent isolated CABG under cardiopulmonary bypass. The patients were allocated into three groups according to the Body Mass Index (BMI) as follows; group 1: severe obese patients; BMI > 35, group 2: obese patients; 30≤BMI≤35, group 3: normal-slightly obese patients; BMI < 30.
The patients in group 3 were older than the group1 and group 2 (65,6 ± 8,3 year vs 63,01 ± 8,0 and 63,57 ± 8,4 year p < 0,05). In group 1 diabetic patients were more than in group 2 and group 3 respectively (54,4% vs 43,4% and 40%, p < 0,05). Urgent operation was more in group 1 than in group 2 and 3 respectively (37,6% vs 17,2% and 21,2% p < 0,05). The patients in group 3 had significantly greater postoperative drainage at 24 h compared with values in group 1 and group 2 (647 ± 142 ml vs. 539 ± 169 ml and 582 ± 133 ml, p < 0,05). Mortality rate in group 1 was 0,8%, 0% in group 2 and 1,2% in group 3 respectively. Wound problem has occurred in 41 patients (9,6%).The percentage of postoperative wound problems was higher in group 1 but did not show statiscially difference. Following discharge a total of 43 (10,1%) patients re-hospitalized within 30 days. Re-hospitalization rate was 16,1% in group1, 9,8% in group 2 and 6,5% in group 3 (p < 0,05).
This study may give an aspect for evaluations of the inhospital-early mortality and morbidity after CABG in female patients in different BMI. Severe obesity is not a risk factor in-hospital mortality in female patients. However, severe obese female patients appear to have more wound problems and re-hospitalization rate after CABG compared to obese and normal-slightly obese patients.
在欧洲心脏风险评估系统中，女性被报道为冠状动脉搭桥术（CABG）的独立危险因素。体型对CABG结果的影响尚不清楚。关于肥胖作为心血管手术后不良结局的危险因素一直存在争议。这项回顾性研究的目的是评估严重肥胖、肥胖和正常 - 轻度肥胖女性患者CABG术后的住院及早期术后结局。
在四年期间，共有427名女性患者在体外循环下接受单纯CABG手术。根据体重指数（BMI）将患者分为三组，如下：第1组：严重肥胖患者；BMI>35，第2组：肥胖患者；30≤BMI≤35，第3组：正常 - 轻度肥胖患者；BMI<30。
第3组患者比第1组和第2组年龄更大（65.6±8.3岁 vs 63.01±8.0岁和63.57±8.4岁，p<0.05）。第1组糖尿病患者分别多于第2组和第3组（54.4% vs 43.4%和40%，p<0.05）。第1组急诊手术分别多于第2组和第3组（37.6% vs 17.2%和21.2%，p<0.05）。与第1组和第2组相比，第3组患者术后24小时引流量明显更多（647±142 ml vs. 539±169 ml和582±133 ml，p<0.05）。第1组死亡率为0.8%，第2组为0%，第3组为1.2%。41名患者（9.6%）出现伤口问题。第1组术后伤口问题发生率较高，但无统计学差异。出院后共有43名（10.1%）患者在30天内再次住院。第1组再住院率为16.1%，第2组为9.8%，第3组为6.5%（p<0.05）。
本研究可为评估不同BMI女性患者CABG术后的住院早期死亡率和发病率提供一个方面。严重肥胖不是女性患者住院死亡率的危险因素。然而，与肥胖和正常 - 轻度肥胖患者相比，严重肥胖女性患者CABG术后似乎有更多的伤口问题和再住院率。
