Intra-abdominal hypertension in obese patients undergoing coronary surgery: A prospective observational study (original) (raw)
Related papers
Annals of intensive care, 2016
Intra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. Better recognition of clinically important thresholds is necessary. Increased intra-abdominal pressure (IAP) is associated with renal dysfunction, and renal failure is one of the most consistently described organ dysfunctions associated with IAH. Obesity is also associated with kidney injury. The underlying mechanisms are not yet fully understood. Increased IAP may be a link in this association. The aim of this study was firstly to find the range in values of intra-abdominal pressure (IAP) in cardiothoracic surgery patients a secondly to investigate the relationship between central obesity, body mass index (BMI) and IAP and thirdly to investigate the relationship between IAP, inflammation and renal function in this population. Consecutive adult patients admitted to the cardiothoracic unit of the intensive care unit (ICU) after undergoing elective cardiot...
The global burden of obesity is on a rising trend and is a major aetiopathogenic factor for noncommunicable diseases, prevalence of obesity-related complications including cardiovascular risk factors such as diabetes, hypertension and dyslipidemia. But numerous studies have documented an obesity paradox in which overweight and obese people with cardiovascular disease have a better prognosis compared with patients with normal body mass index (BMI). This prospective observational study aims to evaluate the effects of obesity on early post-operative outcomes after coronary artery bypass grafting (CABG). This is a prospective study, which includes total 100 patients of multi-vessel CAD who has undergone elective CABG. These patients have been divided in two groups: Group I with 54 patients having BMI> 30 and Group II with 46 patients having BMI< 30. Aim-This study aims to evaluate the effects of obesity on the early post-operative outcomes following CABG like post-operative ventilation time, duration of ICU and hospital stay, improvement in ejection fraction, wound infection, CVA, renal impairment, hepatic insufficiency and mortality. Result: Our study demonstrated a significantly prolonged duration of hospital stay and increased wound infection rates in obese patients, but no statistically significant difference in other parameters between the two groups.
Journal of Cardiothoracic and Vascular Anesthesia, 2012
Objectives: Obesity is a risk factor for morbidity after isolated coronary artery bypass grafting. This study aimed to analyze the sole effect of body mass index (BMI) on early morbidity and mortality in patients after isolated coronary artery bypass grafting. Design: This study was retrospective and used an electronic database of anesthesia information management. Setting: A single community hospital. Participants: The data of 803 consecutive patients after isolated on-pump coronary artery bypass grafting were analyzed retrospectively; off-pump cases were excluded. Intervention: According to measured BMI, patients were divided into 5 groups: underweight (BMI <20 kg/m 2), normal weight (BMI 20.0-24.9 kg/m 2), overweight (BMI 25.0-29.9 kg/m 2), obese (BMI 30.0-34.9 kg/m 2), and morbidly obese (BMI >34.9 kg/m 2). Early postoperative morbidity and mortality were evaluated using logistic regression analysis. Measurements and Main Results: Early cumulative postoperative mortality was 3.9% (32 of 803 patients). Mortality was recorded in 3 underweight (n ؍ 15, 20%, odds ratio [OR] 6.54, p ؍ 0.001), 9 normal-weight (n ؍ 159, 5.7%, OR 1.62, p ؍ 0.228), 12 overweight (n ؍ 371, 3.2%, OR 0.68, p ؍ 0.314), 6 obese (n ؍ 199, 3.0%, OR 0.69, p ؍ 0.421), and 2 morbidly obese (n ؍ 59, 3.4%, OR 0.83, p ؍ 0.808) patients. Prolonged intensive care unit stay (p < 0.001), prolonged hospital stay (p < 0.001), and mortality (p ؍ 0.01) were significantly more common in patients in the underweight group than in the other groups. Univariate and multivariate logistic regression analyses showed that underweight, hypertension, and chronic renal failure were independent risk factors for mortality. Conclusions: Underweight patients with a BMI <20 kg/m 2 are at increased risk of postoperative complications and mortality compared with normal-weight or overweight subjects.
Journal of the American Heart Association, 2016
Better understanding of the relationship between obesity and postsurgical adverse outcomes is needed to provide quality and efficient care. We examined the relationship of obesity with the incidence of early adverse outcomes and in-hospital length of stay following coronary artery bypass grafting surgery. We analyzed data from 7560 patients who underwent coronary artery bypass grafting. Using body mass index (BMI; in kg/m(2)) of 18.5 to 24.9 as a reference, the associations of 4 BMI categories (25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40.0) with rates of operative mortality, overall early complications, subgroups of early complications (ie, infection, renal and pulmonary complications), and length of stay were assessed while adjusting for clinical covariates. There was no difference in operative mortality; however, higher risks of overall complications were observed for patients with BMI 35.0 to 39.9 (adjusted odds ratio 1.35, 95% CI 1.11-1.63) and ≥40.0 (adjusted odds ratio 1.56, 95% ...
Does Obesity Affect Early Results after Coronary Artery Bypass Grafting
World Journal of Cardiovascular Surgery, 2017
Background: The aim of this study was to quantify the effect of obesity on early results after coronary artery bypass grafting (CABG). Methods: A retrospective cohort study of patients underwent isolated CABG from January 2000 through December 2012 was conducted. 586 patients were classified into two groups: Obese (n = 100) BMI ≥ 30 kg/m2 and non-obese (n = 486) BMI ≤ 30kg/m2. Results: The obese patients included more women (p 0.01), hypertensives (p = 0.01) and dyslipidemics (p = 0001). The CPB, aortic champ times and number of bypass graft were similar between the groups (p = 0.35, p = 0.51 and p = 0.59 respectively). Also the composite of in-hospital mortality and postoperative complication didn’t differ between the groups. The incidence of perioperative myocardial infarction, and need for inotropic drugs or IABP were significantly less in obese patients (p = 0.028, p = 0.031 and p 0.01 respectively). Conclusions: The current study showed that obesity is not a risk factor of adve...
International Cardivascular Research Journal, 2012
Background: A retrospective study was conducted to determine whether obesity is a predictor of mortality, morbidity or early readmission to hospital after coronary artery bypass graft (CABG). Method: We analyzed a large cohort of 1057 patients who had undergone isolated CABG. BMI (body mass index) was used as the measure of obesity. The preoperative, intera operative and postoperative risk factors as well as the complication and 30-day mortality rates were compared between the two groups (624 (65.5%) normal-weight and 328 (34.5%) obese patients). Chi square test and logistic regression were used in univariate and multivariate respectively. Results: Of the 1057 patients, 59% had a normal weight and 31% were obese. An increased BMI did not increase the risk of 30-day mortality. In addition, increased BMI was not a predictor of the major complications; arrhythmia, renal complications, neurological complications, pulmonary embolism (PE) except myocardial infarction(MI) (1.8% vs 0.3% with p-value= 0.015). Also investigation on mechanical ventilation time, Reintubation, length of stay in ICU, length of stay in hospital, and readmitting as postoperative variables revealed no significant difference on these two groups(normal-weight and obese patients) Conclusion: Obesity increased myocardial infarction after CABG, but it did not affect the other situations.
International Journal of Environmental Research and Public Health, 2022
Background: Arterial hypertension (HTN) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse the prevalence and evolution of HTN and weight loss in patients suffering from morbid obesity before and after bariatric surgery, during a follow-up period of five years. Methods: A before-and-after study was carried out on severely obese patients undergoing Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (SBP) > 140 mmHg and/or diastolic (DBP) > 90 mmHg. HTN remission was defined as normalisation of blood pressure (BP) maintained after discontinuation of medical treatment, and HTN recurrence was considered when HTN diagnostic criteria reappeared after remission. Weight loss during the study period was evaluated for each patient, calculating excess weight loss percentage (% EWL) and BMI loss percentage (% BMIL) with reference ...
2008
The aim of the present study was to analyze the changes in intra-abdominal pressure in patients undergoing dif- ferent cardiac procedures with extracorporeal circulation (ECC). Patients and methods: IAP was measured in 100 patients undergoing CABG or valve replacement (VR) with ECC. IAP was measured in the urinary bladder at six measurement points: 1/ just before anaesthesia, 2/ 10 min- utes after ECC; 3/ just after surgery, 4/ one hour after the completed procedure, 5/ 6 hours after the completed pro- cedure, 6/ 18 hours after the procedure. Additionally, IAP was correlated with heart rate (HR), mean artery pres- sure (MAP and central venous pressure (CVP). According to cardiac procedure, patients were divided into two groups: A/ CABG, B/ VR. Results: In all patients, ECC resulted in an increase in IAP from 2nd to 6th measurement points. There were sig- nificant correlations between: IAP and BMI (p < 0.001; R = 0.3487), IAP and the duration of: anaesthesia and sur- gery from 2nd...
Obesity and Risk of Adverse Outcomes Associated With Coronary Artery Bypass Surgery
Circulation, 1998
Background-Obesity is frequently cited as a risk factor for adverse outcomes of major surgery. The results of prior studies of the relationship between obesity and risk of adverse outcomes of coronary artery bypass grafting (CABG) have been contradictory because of insufficient power to assess relatively infrequent outcomes or data to adjust for confounding factors. Methods and Results-Data on patient age, sex, height, weight, medical history, current clinical status, and treatment factors were assessed prospectively among 11 101 consecutive patients undergoing CABG. Body mass index (BMI) was used as the measure of obesity and was categorized as nonobese (1st to 74th percentiles), obese (75th to 94th percentiles), or severely obese (95th to 100th percentiles). Adverse outcomes occurring in-hospital, including mortality, intraoperative/postoperative cerebrovascular accident (CVA), postoperative bleeding, and sternal wound infection, were defined prospectively. Associations between obesity and postoperative outcomes were assessed by use of logistic regression to adjust for potentially confounding variables. Although obesity was not associated with increased mortality (adjusted odds ratio [OR], 1.16; Pϭ.261) or postoperative CVA (adjusted OR, 1.06; Pϭ.765), risks of sternal wound infection were substantially increased in the obese (adjusted OR, 2.10; confidence interval [CI], 1.45 to 3.06; PϽ.001) and severely obese (adjusted OR, 2.74; CI, 1.49 to 5.02; Pϭ.001). On the other hand, rates of postoperative bleeding were significantly lower in the obese (adjusted OR, 0.66; CI, 0.49 to 0.90; Pϭ.009) and severely obese (adjusted OR, 0.40; CI, 0.20 to 0.81; Pϭ.011). Conclusions-With the exception of sternal wound infection, the perception among clinicians that obesity predisposes to various postoperative complications with CABG is not supported by these data. Further work is needed to understand the apparent protective effect of obesity on risks of postoperative bleeding. (Circulation. 1998;97:1689-1694.)
Surgical Endoscopy, 2019
Background Arterial hypertension (HTN) is one of the most important risk factors for the development and progression of chronic kidney disease (CKD). Rapid weight loss after bariatric interventions has a positive impact on blood pressure levels of hypertensive patients. The aim of our study is to assess the prevalence of HTN in patients with CKD after bariatric surgery (BS). Methods We retrospectively reviewed severely obese patients who underwent BS from 2010 to 2017. We used guidelines of the American College of Cardiology to define HTN. Only patients meeting ACC criteria and the calculation of estimated glomerular filtration rate (eGFR) using CKD epidemiology collaboration study equation preoperatively and at 12-month follow-up were included in the analysis. Results From a total of 2900 patients, 29.13% (845) met the required criteria and had variables for the calculation of eGFR recorded preoperatively. 36.92% (312) had preoperative HTN and s classified as CKD stage ≥ 2. We observed a predominantly female population 63.83% (203) with mean age of 54.10 ± 11.58. Patients preoperatively classified in CKD 2, 3a, and 3b exhibited the greatest prevalence reduction of HTN at 12-month follow-up (68.59%, n = 214 vs. 36.59%, n = 114; 16.67%, n = 52 vs. 6.41%, n = 20; 7.69%, n = 24 vs. 1.28%, n = 4; p < 0.0001). A marked improvement in CKD was also observed along with improvement in HTN. The greatest benefit corresponded to patients classified preoperatively in CKD 2, 3a and 3b. A total of n = 70 (62.5%) patients with HTN were classified as CKD 2 preoperatively compared to n = 55 (49.11%) at 12-month follow-up (p = 0.0436). Similarly, n = 22 (19.64%) patients with HTN were classified preoperatively as CKD 3a compared to n = 7 (6.25%) and n = 12 (10.71%) patients as CKD 3b compared to n = 4 (3.57%) during the same time period (p = 0.0028, p = 0.0379, respectively). Conclusions Rapid weight loss after BS significantly reduces prevalence of HTN in all stages of CKD at 12-month followup. Additionally, there was a positive impact on classification of CKD at 12-month follow-up.