Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery

Ravi K. Ghanta, Damien J. LaPar, Qianzi Zhang, Vishal Devarkonda, James M. Isbell, Leora T. Yarboro, John A. Kern, Irving L. Kron, Alan M. Speir, Clifford E. Fonner, Gorav Ailawadi

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background-Despite the epidemic rise in obesity, few studies have evaluated the effect of obesity on cost following cardiac surgery. We hypothesized that increasing body mass index (BMI) is associated with worse risk-adjusted outcomes and higher cost. Methods and Results-Medical records for 13 637 consecutive patients who underwent coronary artery bypass grafting (9702), aortic (1535) or mitral (837) valve surgery, and combined valve-coronary artery bypass grafting (1663) procedures were extracted from a regional Society of Thoracic Surgeons certified database. Patients were stratified by BMI: normal to overweight (BMI 18.5-30), obese (BMI 30-40), and morbidly obese (BMI > 40). Differences in outcomes and cost were compared between BMI strata and also modeled as a continuous function of BMI with adjustment for preoperative risk using Society of Thoracic Surgeons predictive risk indices. Morbidly obese patients incurred nearly 60% greater observed mortality than normal weight patients. Moreover, morbidly obese patients had greater than 2-fold increase in renal failure and 6.5-fold increase in deep sternal wound infection. After risk adjustment, a significant association was found between BMI and mortality (P < 0.001) and major morbidity (P < 0.001). The risk-adjusted odds ratio for mortality for morbidly obese patients was 1.57 (P=0.02) compared to normal patients. Importantly, risk-adjusted total hospital cost increased with BMI, with 17.2% higher costs in morbidly obese patients. Conclusions-Higher BMI is associated with increased mortality, major morbidity, and cost for hospital care. As such, BMI should be more strongly considered in risk assessment and resource allocation.

Original languageEnglish (US)
Article numbere003831
JournalJournal of the American Heart Association
Volume6
Issue number3
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Thoracic Surgery
Body Mass Index
Obesity
Morbidity
Costs and Cost Analysis
Mortality
Risk Adjustment
Hospital Costs
Coronary Artery Bypass
Resource Allocation
Wound Infection
Mitral Valve
Medical Records
Renal Insufficiency
Odds Ratio
Databases
Weights and Measures

Keywords

  • Complication
  • Cost
  • Obesity
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ghanta, R. K., LaPar, D. J., Zhang, Q., Devarkonda, V., Isbell, J. M., Yarboro, L. T., ... Ailawadi, G. (2017). Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery. Journal of the American Heart Association, 6(3), [e003831]. https://doi.org/10.1161/JAHA.116.003831

Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery. / Ghanta, Ravi K.; LaPar, Damien J.; Zhang, Qianzi; Devarkonda, Vishal; Isbell, James M.; Yarboro, Leora T.; Kern, John A.; Kron, Irving L.; Speir, Alan M.; Fonner, Clifford E.; Ailawadi, Gorav.

In: Journal of the American Heart Association, Vol. 6, No. 3, e003831, 01.01.2017.

Research output: Contribution to journalArticle

Ghanta, RK, LaPar, DJ, Zhang, Q, Devarkonda, V, Isbell, JM, Yarboro, LT, Kern, JA, Kron, IL, Speir, AM, Fonner, CE & Ailawadi, G 2017, 'Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery', Journal of the American Heart Association, vol. 6, no. 3, e003831. https://doi.org/10.1161/JAHA.116.003831
Ghanta, Ravi K. ; LaPar, Damien J. ; Zhang, Qianzi ; Devarkonda, Vishal ; Isbell, James M. ; Yarboro, Leora T. ; Kern, John A. ; Kron, Irving L. ; Speir, Alan M. ; Fonner, Clifford E. ; Ailawadi, Gorav. / Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 3.
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abstract = "Background-Despite the epidemic rise in obesity, few studies have evaluated the effect of obesity on cost following cardiac surgery. We hypothesized that increasing body mass index (BMI) is associated with worse risk-adjusted outcomes and higher cost. Methods and Results-Medical records for 13 637 consecutive patients who underwent coronary artery bypass grafting (9702), aortic (1535) or mitral (837) valve surgery, and combined valve-coronary artery bypass grafting (1663) procedures were extracted from a regional Society of Thoracic Surgeons certified database. Patients were stratified by BMI: normal to overweight (BMI 18.5-30), obese (BMI 30-40), and morbidly obese (BMI > 40). Differences in outcomes and cost were compared between BMI strata and also modeled as a continuous function of BMI with adjustment for preoperative risk using Society of Thoracic Surgeons predictive risk indices. Morbidly obese patients incurred nearly 60{\%} greater observed mortality than normal weight patients. Moreover, morbidly obese patients had greater than 2-fold increase in renal failure and 6.5-fold increase in deep sternal wound infection. After risk adjustment, a significant association was found between BMI and mortality (P < 0.001) and major morbidity (P < 0.001). The risk-adjusted odds ratio for mortality for morbidly obese patients was 1.57 (P=0.02) compared to normal patients. Importantly, risk-adjusted total hospital cost increased with BMI, with 17.2{\%} higher costs in morbidly obese patients. Conclusions-Higher BMI is associated with increased mortality, major morbidity, and cost for hospital care. As such, BMI should be more strongly considered in risk assessment and resource allocation.",
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AU - LaPar, Damien J.

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AU - Isbell, James M.

AU - Yarboro, Leora T.

AU - Kern, John A.

AU - Kron, Irving L.

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AB - Background-Despite the epidemic rise in obesity, few studies have evaluated the effect of obesity on cost following cardiac surgery. We hypothesized that increasing body mass index (BMI) is associated with worse risk-adjusted outcomes and higher cost. Methods and Results-Medical records for 13 637 consecutive patients who underwent coronary artery bypass grafting (9702), aortic (1535) or mitral (837) valve surgery, and combined valve-coronary artery bypass grafting (1663) procedures were extracted from a regional Society of Thoracic Surgeons certified database. Patients were stratified by BMI: normal to overweight (BMI 18.5-30), obese (BMI 30-40), and morbidly obese (BMI > 40). Differences in outcomes and cost were compared between BMI strata and also modeled as a continuous function of BMI with adjustment for preoperative risk using Society of Thoracic Surgeons predictive risk indices. Morbidly obese patients incurred nearly 60% greater observed mortality than normal weight patients. Moreover, morbidly obese patients had greater than 2-fold increase in renal failure and 6.5-fold increase in deep sternal wound infection. After risk adjustment, a significant association was found between BMI and mortality (P < 0.001) and major morbidity (P < 0.001). The risk-adjusted odds ratio for mortality for morbidly obese patients was 1.57 (P=0.02) compared to normal patients. Importantly, risk-adjusted total hospital cost increased with BMI, with 17.2% higher costs in morbidly obese patients. Conclusions-Higher BMI is associated with increased mortality, major morbidity, and cost for hospital care. As such, BMI should be more strongly considered in risk assessment and resource allocation.

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