Moulton M J, Creswell L L, Mackey M E, Cox J L, Rosenbloom M
Department of Surgery, Washington University, St Louis, Mo., USA.
Circulation. 1996 Nov 1;94(9 Suppl):II87-92.
Obese patients undergoing cardiac surgery are often thought to have prohibitive perioperative risk despite the lack of sufficient data to support this assumption.
To assess the significance of obesity as a risk factor in patients undergoing cardiac surgery, we analyzed data from 2299 patients undergoing procedures requiring cardiopulmonary bypass from January 1, 1991, to December 31, 1993. Obesity was defined by use of the body mass index, defined as weight in kilograms divided by height in meters squared. Potential adverse outcomes analyzed included operative mortality, deep sternal wound infection, superficial sternal wound infection, infection at the saphenous vein harvest site, stroke, renal failure, adult respiratory distress syndrome, prolonged mechanical ventilation, pneumonia, sepsis, atrial arrhythmias, pulmonary embolism, need for early reexploration for bleeding, and ventricular arrhythmias. To control for the confounding effects of other risk factors, we performed a multivariate logistic regression analysis. Potential covariates considered in the logistic model included age, sex, race, history of reoperation, congestive heart failure, prior myocardial infarction, renal failure, diabetes, hypertension, chronic obstructive pulmonary disease or stroke, and cardiopulmonary bypass and aortic cross-clamp time. Twenty-five percent of patients (567/2299) were classified as obese. The results of the multivariate regression demonstrated that obesity was a risk factor only for superficial sternal wound infection (P < .001; odds ratio, 2.3), leg infections (P = .005; odds ratio, 1.8), and atrial dysrhythmias (P = .04; odds ratio, 1.2). Notably, obesity did not predispose toward increased pulmonary complications or deep sternal wound infection (P = .65).
With the exception of superficial wound complications and atrial dysrhythmias, obesity is not a significant multivariate risk factor for adverse outcomes. The results indicate that obese patients may safely undergo cardiac surgery with due attention to technical considerations designed to minimize wound complications.
尽管缺乏足够数据支持这一假设，但接受心脏手术的肥胖患者通常被认为围手术期风险过高。
为评估肥胖作为心脏手术患者风险因素的重要性，我们分析了1991年1月1日至1993年12月31日期间2299例接受需要体外循环手术患者的数据。肥胖通过体重指数定义，即体重（千克）除以身高（米）的平方。分析的潜在不良结局包括手术死亡率、深部胸骨伤口感染、浅表胸骨伤口感染、大隐静脉取血管部位感染、中风、肾衰竭、成人呼吸窘迫综合征、机械通气时间延长、肺炎、败血症、房性心律失常、肺栓塞、因出血需要早期再次手术以及室性心律失常。为控制其他风险因素的混杂效应，我们进行了多因素逻辑回归分析。逻辑模型中考虑的潜在协变量包括年龄、性别、种族、再次手术史、充血性心力衰竭、既往心肌梗死、肾衰竭、糖尿病、高血压、慢性阻塞性肺疾病或中风，以及体外循环和主动脉阻断时间。25%的患者（567/2299）被归类为肥胖。多因素回归结果表明，肥胖仅是浅表胸骨伤口感染（P < .001；比值比，2.3）、腿部感染（P = .005；比值比，1.8）和房性心律失常（P = .04；比值比，1.2）的风险因素。值得注意的是，肥胖并未使肺部并发症或深部胸骨伤口感染增加（P = .65）。
除浅表伤口并发症和房性心律失常外，肥胖并非不良结局的显著多因素风险因素。结果表明，肥胖患者在适当关注旨在将伤口并发症降至最低的技术因素的情况下，可安全地接受心脏手术。
