Department of Nursing, Fujian Medical University, Fuzhou, China.
Department of Nursing, Union Hospital, Fujian Medical University, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
J Cardiothorac Surg. 2021 Mar 23;16(1):47. doi: 10.1186/s13019-021-01432-y.
Abnormal body mass index (BMI) has been related to a higher risk of adverse outcomes in patients undergoing cardiac surgery. However, the effects of BMI in patients with acute type A aortic dissection (AAAD) on postoperative outcomes remain unclear. This study aimed to explore the relationships between BMI and in-hospital major adverse outcomes (MAO) in AAAD patients.
Patients who underwent AAAD surgery at Cardiac Medical Center of Fujian Province from June 2013 to March 2020 were retrospectively evaluated. They were divided into three groups on the basis of Chinese BMI classification established by the World Health Organization: normal weight group (BMI 18.5-23.9 kg/m), overweight group (BMI 24-27.9 kg/m), and obese group (BMI >28 kg/m). Patients' baseline characteristics, preoperative, operative, and postoperative data were collected. A multivariable logistic regression analysis model was performed to identify the association between BMI and MAO in AAAD patients.
Of 777 cases, 31.9% were normal weight, 52.5% were overweight, and 15.6% were obese. A total of 160(20.6%) patients died in-hospital. There was a significant difference between the three groups for MAO (62.9% vs 72.1% vs 77.7%, respectively, P = 0.006). The incidence of postoperative complications did not differ among the three groups, except for postoperative bleeding, and prolonged mechanical ventilation, the proportion of which were higher in the overweight and obese groups. Besides, multivariable logistic regression analysis demonstrated that a higher risk of MAO in the overweight [odds ratios (ORs):1.475, 95%CI:1.006-2.162], and obese patients (ORs:2.147, 95%CI:1.219-3.782) with reference to the normal weight patients, and age, white blood cell, prior stroke and cardiopulmonary bypass time were also associated with in-hospital MAO (P<0.05).
BMI is independently associated with higher in-hospital MAO in patients who underwent AAAD surgery.
异常体重指数（BMI）与心脏手术后不良结局的风险增加有关。然而，急性 A 型主动脉夹层（AAAD）患者 BMI 对术后结局的影响尚不清楚。本研究旨在探讨 BMI 与 AAAD 患者住院期间主要不良结局（MAO）的关系。
回顾性分析 2013 年 6 月至 2020 年 3 月在福建省心血管病研究所接受 AAAD 手术的患者。根据世界卫生组织（WHO）建立的中国 BMI 分类标准，将患者分为三组：正常体重组（BMI 18.5-23.9kg/m）、超重组（BMI 24-27.9kg/m）和肥胖组（BMI>28kg/m）。收集患者的基线特征、术前、术中和术后数据。采用多变量逻辑回归分析模型，探讨 AAAD 患者 BMI 与 MAO 的关系。
777 例患者中，正常体重者占 31.9%，超重者占 52.5%，肥胖者占 15.6%。共有 160 例（20.6%）患者住院期间死亡。三组间 MAO 发生率差异有统计学意义（分别为 62.9%、72.1%和 77.7%，P=0.006）。三组间术后并发症发生率无差异，但超重和肥胖组术后出血和机械通气时间延长的比例较高。此外，多变量逻辑回归分析显示，与正常体重患者相比，超重患者（比值比[OR]：1.475，95%可信区间[CI]：1.006-2.162）和肥胖患者（OR：2.147，95%CI：1.219-3.782）发生 MAO 的风险更高，年龄、白细胞、既往卒中及体外循环时间也与住院 MAO 相关（P<0.05）。
BMI 与接受 AAAD 手术的患者住院期间 MAO 发生率升高独立相关。
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