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Eur J Cardiothorac Surg 2005;27:530
© 2005 Elsevier Science NL
Letter to the Editor |
Cardiac Surgery Division, Regional Cardiac Center, Morriston Hospital, SA6 6NL Swansea, UK
Received 27 November 2004; accepted 15 December 2004.
* Corresponding author. Tel.: +44 1792 702222; fax: +44 1792 703242, +44 79 40451630 (mobile). (E-mail: ptotaro{at}yahoo.com).
Key Words: Coronary artery diseases • Myocardial revascularization • Obesity
We read with interest the paper by Lindhout and co-authors from Nijemegen, addressing the important issue of the early mortality and morbidity after CABG in obese patients [1]. As the authors correctly stated in their paper, the prevalence of obesity has taken on epidemics form and this is deeply affecting the characteristics of the patients referred for CABG. We congratulate the colleague from The Netherlands for the excellent results they report in these subset of patients, but we would be briefly report our experience and add few comments. We do think, in fact, that the conclusions of their study, although based on correct statistical analysis, do not reflect the true and complete situation. We are undertaking a similar study in our centre (in south Wales) and the breakdown of our population gives a complete different figures. Indeed in our division out of 3275 patients undergoing CABG over the past 7 years, 937 (28.6%) were obese (BMI>30) compared to 18.2% to the population of the study from Nijemegen. Furthermore the mean BMI of our total population was 28.4±4.2 with a median of 28 and a maximum value of 52 (compared to 27.1±3.6; 26.9 and 46.2, respectively, of the study population). It is also remarkable that, in our population, although the number of patient with ‘extreme’ obesity (BMI>40) [2] was relatively low (0.6% of the total–2.2% of the obese patients), the percentage of patients with ‘moderate’ obesity (BMI>35<40) was significantly higher (220 patients—5.8% of the total–22% of the obese patients). These findings are similar to those of a recent study from the group of Minneapolis [3]. Probably due to these differences in the patient population, our preliminary results are quite different with a significant increased incidence of prolonged ITU/HDU stay and Ventilation time in patients with BMI>35 (no statistical differences in mortality). We also found, in this subset of patients, a significant increased incidence of chest infection requiring antibiotics. Different outcome according to the degree of obesity have been, however, previously reported in terms of increased mortality [2], prolonged mechanical ventilation [4] and, recently, in terms of increased risk of sternal dehiscence [3]. In conclusion we believe that it is important to stress that, although CABG can be performed with satisfactory results in obese patients, the degree of the obesity plays a key role in increasing postoperative morbidity and, therefore, in causing a less favourable outcome.
References
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