Evidence map›Paper›PMID 28034901›Full record

SynthesisCirculation2017

Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis.

Giovanni Mariscalco, Marcin J Wozniak, Alan G Dawson, Giuseppe F Serraino, Richard Porter, Mintu Nath, Catherine Klersy, Tracy Kumar, Gavin J Murphy

Registry-linked trialOpen access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Circulation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04393636 (Randomized Controlled Trial of Digital Cardiac Counseling in Patients With Delayed Cardiac Surgical Treatment Due to Covid-19 Pandemic), which is not on this map. Cited by 99 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
99citing papers in PubMed, 5 pooled it
14.8field-weighted citation impact, top 1% of its field
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.

NCT04393636 nacompletednot on this mapstarted 2020, after this paper: background citation

Randomized Controlled Trial of Digital Cardiac Counseling in Patients With Delayed Cardiac Surgical Treatment Due to Covid-19 Pandemic (DCC Trial)

TypeinterventionalSponsorAcademisch Ziekenhuis MaastrichtRan2020 to 2024Enrolled394ConditionsCardiovascular Diseases, Cardiovascular Risk FactorArmsDigital cardiac Counseling
3 · Its place in the literature

Who cites it

99 citing papers in PubMed, 5 syntheses or guidelines pooled it, 219 citations in OpenAlex.

  1. Pooled it
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  5. The impact of body mass index on mortality rates of hip fracture patients: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022
    Pooled it
  6. Article
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  8. Excess Epicardial Fat and Myocardial Remodeling After Mitral Valve Surgery.Journal of cardiovascular development and disease · 2026
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39 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Giovanni MariscalcoFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.). gm247@le.ac.uk.
Marcin J WozniakFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Alan G DawsonFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Giuseppe F SerrainoFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Richard PorterFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Mintu NathFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Catherine KlersyFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Tracy KumarFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Gavin J MurphyFrom Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, UK (G.M., M.J.W., A.G.D., G.F.S., M.N., T.K., G.J.M.); Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK (R.P.); and Service of Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy (C.K.).
Glenfield Hospital · GBUniversity Hospitals of Leicester NHS Trust · GB

Funding

British Heart Foundation CH/12/1/29419British Heart Foundation RG/13/6/29947
6 · The paper itself

Abstract

backgroundIn an apparent paradox, morbidity and mortality are lower in obese patients undergoing cardiac surgery, although the nature of this association is unclear. We sought to determine whether the obesity paradox observed in cardiac surgery is attributable to reverse epidemiology, bias, or confounding.

methodsData from the National Adult Cardiac Surgery registry for all cardiac surgical procedures performed between April 2002 and March 2013 were extracted. A parallel systematic review and meta-analysis (MEDLINE, Embase, SCOPUS, Cochrane Library) through June 2015 were also accomplished. Exposure of interest was body mass index categorized into 6 groups according to the World Health Organization classification.

resultsA total of 401 227 adult patients in the cohort study and 557 720 patients in the systematic review were included. A U-shaped association between mortality and body mass index classes was observed in both studies, with lower mortality in overweight (adjusted odds ratio, 0.79; 95% confidence interval, 0.76-0.83) and obese class I and II (odds ratio, 0.81; 95% confidence interval, 0.76-0.86; and odds ratio, 0.83; 95% confidence interval, 0.74-0.94) patients relative to normal-weight patients and increased mortality in underweight individuals (odds ratio, 1.51; 95% confidence interval, 1.41-1.62). In the cohort study, a U-shaped relationship was observed for stroke and low cardiac output syndrome but not for renal replacement therapy or deep sternal wound infection. Counter to the reverse epidemiology hypotheses, the protective effects of obesity were less in patients with severe chronic renal, lung, or cardiac disease and greater in older patients and in those with complications of obesity, including the metabolic syndrome and atherosclerosis. Adjustments for important confounders did not alter our results.

conclusionsObesity is associated with lower risks after cardiac surgery, with consistent effects noted in multiple analyses attempting to address residual confounding and reverse causation.

Indexed as

Body Mass IndexCardiac Surgical ProceduresComorbidityDatabases, FactualHeart DiseasesHospital MortalityHumansObesityOdds RatioRisk Factorsadultcardiac surgical proceduresmorbiditymortalityobesity

Identifiers

PMID28034901
OpenAlexW2562216574

What OpenQuestion holds

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Registered trials

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.