Thorac Cardiovasc Surg 2016; 64 - ePP23
DOI: 10.1055/s-0036-1571706

Early Perioperative and 6 Months Follow-up Morbidity and Mortality in Obese Patients Correlate with Metabolic and Anthropometric Parameters

B. Niemann 1, P. Grieshaber 1, S. Rohrbach 2, S. Babak 1, A. Möller 1, S. Sommerbeck 1, I. Shefranek 1, A. Böning 1
  • 1Justus Liebig Universität Giessen, Klinik für Herz- Kinderherz- und Gefäßchirurgie, Giessen, Germany
  • 2Justus Liebig Universität Giessen, Physiologisches Institut, Giessen, Germany

Aim: Obesity is associated with greater survival in some chronic diseases and may thus be protective in cardiac surgery. However, severe obesity, diabetes and metabolic syndrome are well-established confounders of cardiovascular pathology. Overwhelming incidence of metabolic deterioration especially in young patients, resulting in premature therapeutic needs in those, is evident nowadays. Here we aimed to identify parameters (anthropometry /serum), determining increased perioperative risk and reduced long-term outcome.

Method: A total of 500 elective patients (prospective; all comers) undergoing coronary bypass surgery, aortic- and mitral valve- and aortic surgery underwent anthropometric measurements (bodyweight, body height, waist-, hip (HC)- and medial calf circumference) and metabolic serum profiling (cholesterol (CC), HDL, LDL, triglycerides (TG), glucose (GLC), insulin (INS), protein c (PC), HbA1c). Predictability of death, stroke, cardiac ischemia and need of revascularization, atrial fibrillation and wound healing 30 days after surgery, 1 month and 6 months after discharge were analyzed.

Results: Patients exhibited moderate (A; 23%; BMI >30–35 kg/m2), intermediate (B; 6%; BMI >35–40 kg/m2) or severe (C; 2%; BMI >40–45 kg/m2) obesity. Age correlated inversely to BMI ([years ± SEM]; lean (72.7 ± 3.6) BMI A (69.1 ± 0.6) BMI B (67.4 ± 0.9) BMI C (64.2 ± 2.8); p = 0.02). Obesity correlated with calf- (p < 0.001), waist- (p < 0.001), hip- (p < 0.001) circumference, serum levels of CC, LDL, TG, PC, INS, GLC, HBA1c and 1/HDL. Mortality (30 days/1 month/6 months) was 2%/2.2%/2.4%. Death correlated to anthropometry and serology (30 days, HC; p = 0.043), (1 month, HC; p = 0.019/CC; p = 0.048), (6 months HC; p = 0.035/PC; p < 0.001). Prevalence of stroke correlated to elevated metabolic serum-parameters (30 days, HbA1c, p < 0.001/ TG p = 0.021). Overall risk of obesity-associated morbidity (atrial fibrillation, delirium, wound healing disorders) showed positive correlation to elevated TG (p = 0.046). Long-term outcome, defined as a combined end-point of all-cause death, stroke and revascularization/cardiac ischemia, correlated to 1/HDL (p = 0.046), strongly to PC levels (p < 0.001) and only mildly to TG (p = 0.051).

Conclusion: Anthropometric and serological characterization supports identification of obese “metabolic” high-risk-patients. Obesity-associated morbidity increases the risk for atrial fibrillation, wound healing disorders but furthermore the risk for death and stroke.