ArticlePloS one2015
The influence of body mass index on outcomes in patients undergoing cardiac surgery: does the obesity paradox really exist?
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis.Canadian respiratory journal · 2022Pooled it
- Effect of weight-loss diets prior to elective surgery on postoperative outcomes in obesity: A systematic review and meta-analysis.Clinical obesity · 2021Pooled it
- Comparison of High-flow Nasal Cannula (HFNC) and Conventional Oxygen Therapy in Obese Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.In vivo (Athens, Greece)Pooled it
- Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Technical challenges and controversies.JHLT open · 2025Review
- Factors contributing to instability after primary total knee arthroplasty: a twenty five Year retrospective cohort study.International orthopaedics · 2025Article
- Artificial intelligence-based analysis of body composition predicts outcome in patients receiving long-term mechanical circulatory support.Journal of cachexia, sarcopenia and muscle · 2024Article
- The Burden of Obesity in Cardiac Surgery: A 14 years' Follow-Up of 14.754 Patients.Journal of obesity · 2024Article
- High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence.Journal of clinical medicine · 2023Review
- The importance of liver function assessment before cardiac surgery: A narrative review.Frontiers in surgery · 2022Review
- Comparison of Microcirculatory Perfusion in Obese and Non-Obese Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass.Journal of clinical medicine · 2021Article
- Influence of body mass index on outcomes in patients undergoing surgery for diverticular disease.Surgery open science · 2019Article
- Nutritional Status of Elderly Patients after Coronary Artery Bypass Surgery.International journal of environmental research and public health · 2019Article
- CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?Obesity facts · 2019Article
- Economies of scale: body mass index and costs of cardiac surgery in Ontario, Canada.The European journal of health economics : HEPAC : health economics in prevention and care · 2017Article
- Impact of Body Mass Index on Outcomes in Cardiac Surgery.Journal of cardiothoracic and vascular anesthesia · 2016Article
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeObesity influences risk stratification in cardiac surgery in everyday practice. However, some studies have reported better outcomes in patients with a high body mass index (BMI): this is known as the obesity paradox. The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery, and to assess the existence of an obesity paradox in our patients.
methodsA total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospectively studied at our institution. Patients were divided into four groups based on BMI: normal weight (18.5-24.9 kg∙m-2; n = 523; 21.4%), overweight (25-29.9 kg∙m-2; n = 1150; 47%), obese (≥ 30-≤ 34.9 kg∙m-2; n = 624; 25.5%) and morbidly obese (≥ 35kg∙m-2; n = 152; 6.2%). Follow-up was performed in 2,379 patients during the first year.
resultsAfter adjusting for confounding factors, patients with higher BMI presented worse oxygenation and better nutritional status, reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48 h after admission respectively. Obese patients showed a higher risk for Perioperative Myocardial Infarction (OR: 1.768; 95% CI: 1.035-3.022; p = 0.037) and septicaemia (OR: 1.489; 95% CI: 1.282-1.997; p = 0.005). In-hospital mortality was 4.8% (n = 118) and 1-year mortality was 10.1% (n = 252). No differences were found regarding in-hospital mortality between BMI groups. The overweight group showed better 1-year survival than normal weight patients (91.2% vs. 87.6%; Log Rank: p = 0.029. HR: 1.496; 95% CI: 1.062-2.108; p = 0.021).
conclusionsIn our population, obesity increases Perioperative Myocardial Infarction and septicaemia after cardiac surgery, but does not influence in-hospital mortality. Although we found better 1-year survival in overweight patients, our results do not support any protective effect of obesity in patients undergoing cardiac surgery.
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