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Eur J Cardiothorac Surg 2005;27:530-531
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Totaro et al.

Department of Thoracic and Cardiac Surgery 414, Heart Center, Nijmegen University Hospital, St Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

Received 14 December 2004; accepted 15 December 2004.

^* Tel.: +31 243613711; fax: +31 243540129. (E-mail: l.noyez{at}thorax.umcn.nl).

Key Words: Obesity • Mortality • Morbidity

I thank Dr Totaro for his comments about our recent article [1]. In this article we attended several times on the small proportion of extreme obese patients in our study population. Therefore the letter of Dr. Totaro is a valuable completion of our study. In his patient population, about 28.6% had a body mass index (BMI) > 30 and about 5.8% had a BMI >35<40. It is clear, this Welsh population is more obese than the described Dutch population In both studies there is a significant increase of sternal wound problems in the obese group. However, we have no difference in ventilation time, Intensive care and hospital stay. Totaro, and also others [2] have a significant difference of these variables. But also Totaro do not mention if this difference is directly related to obesity or is a result of the increased incidence of wound infections as suggested by Kudivalli et al. [3].

Neither Totaro, nor our study shows a significant difference in mortality. This is interesting because both studies have only a limited number of patients with a BMI >40. and it is only Prabhakar, with a large group of patients with a BMI 40 shows this increased mortality risk. ([2]

In conclusion we agree with Dr Totaro that the degree of the obesity plays a key role in increasing postoperative morbidity and even mortality.

References

1. Lindhout AH, Wouters CW, Noyez L. Influence of obesity om in-hospital and early mortality and morbidity after myocardial revascularization. Eur J Cardiothorac Surg 2004;26:535-541.[Abstract/Free Full Text]
2. Prabhakar G, Haan CK, Peterson ED, Coombs LP, Cruzzavala JL, Murray GF. The risk of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the society of thoracic surgeons' database. Ann Thorac Surg 2002;74:1125-1131.[Abstract/Free Full Text]
3. Kuduvalli M, Grayson AD, Oo AY, Fabri BM, Rashid A. The effect of obesity on mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 2003;23:368-373.[Abstract/Free Full Text]

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