Borracci Raul A, Ingino Carlos A, Miranda Julio Macias
Departamento de Cirugía Cardíaca, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Argentina. E-mail:
Departamento de Cardiología y Cirugía Cardíaca, ENERI-Sagrada Familia, Buenos Aires, Argentina.
Medicina (B Aires). 2018;78(3):171-179.
The relationship between higher body mass index (BMI), decreased morbidity and mortality is known as the "obesity paradox", and has been described in cohorts of patients with hypertension, diabetes, heart failure, coronary and peripheral artery diseases, non-cardiac surgery, and end-stage renal disease. Here we investigated the relationship between BMI and short-term outcomes after adult cardiac surgery to explore the existence of an obesity paradoxical effect. A secondary objective was to perform an updated systematic review to further analyze the association between BMI and 30-day in-hospital mortality after cardiac surgery. A retrospective analysis was performed from a consecutive series of 1823 adult patients who underwent cardiac surgery, that were assigned to five BMI groups: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), class I obese (30-34.9 kg/m2), class II obese (35-39.9 kg/m2), and class III obese or morbidly obese (40-49.9 kg/m2). A systematic review search was performed including controlled trials and observational studies identified in MEDLINE, Embase, SCOPUS, and the Cochrane library (to the end of June 2017). In the present series, overweight and obese patients had similar or slightly lower in-hospital mortality rates after cardiac surgery compared with normal-weight individuals. Conversely, postoperative complication rates increased with higher BMI levels. Most studies included in the review showed that overweight and obese patients had at least the same mortality rate as normal-weight patients, or even a lower death risk. Pooled-data of the meta-analysis provided evidence on the association between higher BMI levels and a lower all-cause in-hospital mortality rate after cardiac surgery.
较高的体重指数（BMI）与发病率和死亡率降低之间的关系被称为“肥胖悖论”，并且已在高血压、糖尿病、心力衰竭、冠状动脉和外周动脉疾病、非心脏手术以及终末期肾病患者队列中得到描述。在此，我们研究了BMI与成人心脏手术后短期结局之间的关系，以探讨肥胖悖论效应的存在。第二个目标是进行一项更新的系统评价，以进一步分析BMI与心脏手术后30天院内死亡率之间的关联。对连续1823例接受心脏手术的成年患者进行了回顾性分析，这些患者被分为五个BMI组：正常体重（18.5 - 24.9 kg/m²）、超重（25 - 29.9 kg/m²）、I级肥胖（30 - 34.9 kg/m²）、II级肥胖（35 - 39.9 kg/m²）以及III级肥胖或病态肥胖（40 - 49.9 kg/m²）。进行了系统评价检索，包括在MEDLINE、Embase、SCOPUS和Cochrane图书馆（截至2017年6月底）中识别出的对照试验和观察性研究。在本系列研究中，超重和肥胖患者心脏手术后的院内死亡率与正常体重个体相似或略低。相反，术后并发症发生率随BMI水平升高而增加。该评价纳入的大多数研究表明，超重和肥胖患者的死亡率至少与正常体重患者相同，甚至死亡风险更低。荟萃分析的汇总数据为较高BMI水平与心脏手术后较低的全因院内死亡率之间的关联提供了证据。
