Evidence map›Paper›PMID 26159363›Full record

ArticleJournal of the American Heart Association2015

Body Mass Index, Outcomes, and Mortality Following Cardiac Surgery in Ontario, Canada.

Ana P Johnson, Joel L Parlow, Marlo Whitehead, Jianfeng Xu, Susan Rohland, Brian Milne

Erratum issuedAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Heart Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 50 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  10. Body Weight's Role in Infective Endocarditis Surgery.Journal of cardiovascular development and disease · 2024
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  18. Association of body mass index with 30-day mortality and red blood cell transfusions in open heart surgery.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Ana P JohnsonDepartment of Public Health Sciences, Queen's University, Kingston, Ontario, Canada (A.P.J.) Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, Ontario, Canada (A.P.J., M.W., J.X., S.R.).
Joel L ParlowDepartment of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada (J.L.P., B.M.).
Marlo WhiteheadInstitute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, Ontario, Canada (A.P.J., M.W., J.X., S.R.).
Jianfeng XuInstitute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, Ontario, Canada (A.P.J., M.W., J.X., S.R.).
Susan RohlandInstitute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston, Ontario, Canada (A.P.J., M.W., J.X., S.R.).
Brian MilneDepartment of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada (J.L.P., B.M.).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe "obesity paradox" reflects an observed relationship between obesity and decreased morbidity and mortality, suggesting improved health outcomes for obese individuals. Studies examining the relationship between high body mass index (BMI) and adverse outcomes after cardiac surgery have reported conflicting results. METHODS AND

resultsThe study population (N=78 762) was comprised of adult patients who had undergone first-time coronary artery bypass (CABG) or combined CABG/aortic valve replacement (AVR) surgery from April 1, 1998 to October 31, 2011 in Ontario (data from the Institute for Clinical Evaluative Sciences). Perioperative outcomes and 5-year mortality among pre-defined BMI (kg/m(2)) categories (underweight <20, normal weight 20 to 24.9, overweight 25 to 29.9, obese 30 to 34.9, morbidly obese >34.9) were compared using Bivariate analyses and Cox multivariate regression analysis to investigate multiple confounders on the relationship between BMI and adverse outcomes. A reverse J-shaped curve was found between BMI and mortality with their respective hazard ratios. Independent of confounding variables, 30-day, 1-year, and 5-year survival rates were highest for the obese group of patients (99.1% [95% Confidence Interval {CI}, 98.9 to 99.2], 97.6% [95% CI, 97.3 to 97.8], and 90.0% [95% CI, 89.5 to 90.5], respectively), and perioperative complications lowest. Underweight and morbidly obese patients had higher mortality and incidence of adverse outcomes.

conclusionsOverweight and obese patients had lower mortality and adverse perioperative outcomes after cardiac surgery compared with normal weight, underweight, and morbidly obese patients. The "obesity paradox" was confirmed for overweight and moderately obese patients. This may impact health resource planning, shifting the focus to morbidly obese and underweight patients prior to, during, and after cardiac surgery.

Indexed as

Body Mass IndexAortic ValveCoronary Artery BypassFemaleHeart Valve Prosthesis ImplantationHumansKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisObesity, MorbidOntarioPatient SelectionProportional Hazards ModelsProtective FactorsRisk Assessmentbody mass indexbypass graftcoronary artery bypass graftmortalityobesity

Identifiers

PMID26159363
PMCPMC4608091

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.