The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery

• Published in: Frontiers in cardiovascular medicine Vol. 8; p. 754934
• Main Authors: Elbaz-Greener, Gabby, Rozen, Guy, Carasso, Shemy, Kusniec, Fabio, Yarkoni, Merav, Marai, Ibrahim, Strauss, Bradley, Wijeysundera, Harindra C., Smart, Frank W., Erez, Eldad, Alcalai, Ronny, Planer, David, Amir, Offer
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 08.10.2021
• Subjects: body mass index (BMI); Cardiovascular Medicine; coronary artery bypass grafting surgery (CABG); ischemic heart; mortality; outcome
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2021.754934

Background: The association between Body Mass Index (BMI) and clinical outcomes following coronary artery bypass grafting (CABG) remains controversial. Our objective was to investigate the real-world relationship between BMI and in-hospital clinical course and mortality, in patients who underwent CABG. Methods: A sampled cohort of patients who underwent CABG between October 2015 and December 2016 was identified in the National Inpatient Sample (NIS) database. Outcomes of interest included in-hospital mortality, peri-procedural complications and length of stay. Patients were divided into 6 BMI (kg/m 2 ) subgroups; (1) under-weight ≤19, (2) normal-weight 20–25, (3) over-weight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) extremely obese ≥40. Multivariable logistic regression model was used to identify predictors of in-hospital mortality. Linear regression model was used to identify predictors of length of stay (LOS). Results: An estimated total of 48,710 hospitalizations for CABG across the U.S. were analyzed. The crude data showed a U-shaped relationship between BMI and study population outcomes with higher mortality and longer LOS in patients with BMI ≤ 19 kg/m 2 and in patients with BMI ≥40 kg/m 2 compared to patients with BMI 20–39 kg/m 2 . In the multivariable regression model, BMI subgroups of ≤19 kg/m 2 and ≥40 kg/m 2 were found to be independent predictors of mortality. Conclusions: A complex, U-shaped relationship between BMI and mortality was documented, confirming the “obesity paradox” in the real-world setting, in patients hospitalized for CABG.