MedicalResearch.com Interview with:
Dr. Mary Forhan OT Reg (Alberta), PhD, Assistant Professor ad
Dr. Tasuku Terada, post-doctoral research fellow
Faculty of Rehabilitation Medicine
University of Alberta
MedicalResearch.com: What is the background for this study?
Response: The prevalence of obesity has increased. Notably, a proportion of severe obesity (body mass index: body weight [kg] divided by height squared [m2]: >40kg/m2) has shown the most significant increase. Greater body mass increases the risk of cardiovascular disease and referrals for coronary artery graft surgery (CABG) have increased in patients with severe obesity. Interestingly, while obesity is often considered to increase the risk of complications and associated health care costs, many studies have reported better prognosis in patients with obesity compared to patients with normal weight, a phenomenon referred to as the obesity paradox. Therefore, it was not clear if patients with severe obesity were at higher risk of complications and contributed to greater resource use. A better understanding of the relationship between obesity and post-surgical adverse outcomes was needed to provide quality and efficient care.
MedicalResearch.com: What are the main findings?
Response: Patients with severe obesity (BMI≥40kg/m2) were 56% more likely to have complications within 30-days of surgery and those with mild to moderate obesity (BMI 30-39.9kg/m2) had a 35% higher risk of complications compared to patients without obesity (BMI 18.5-24.9kg/m2). Compared to patients without obesity, those with obesity had a 60% higher risk for infection with those with severe obesity having a three-fold increased risk of infection. The median hospital stay was one day longer for patients with severe obesity compared to patients without obesity. However, in patients with severe obesity who also had diabetes and who experienced an infection, the hospital stay was 3.2 times longer compared to patients without either condition (diabetes and/or obesity).
MedicalResearch.com: What should readers take away from your report?
Response: The association of severe obesity to post-surgical infections, particularly for those patients who also have diabetes is interesting and warrants further investigation. A better understanding of the types of infections such patients experience and ways in which to prevent infection in such patients is needed. It is important to note that the results of this study do not suggest a causal relationship and readers are cautioned not to conclude that obesity is the cause of infection or longer in-hospital length of stay.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We attempted to identify potential risks associated with patients undergoing cardiac surgery in patients living with obesity. While we showed infection is a potentially controllable risk factor in patients with severe obesity, our study did not determine types or locations of infections. Future studies identifying infection types and locations in patients with severe obesity undergoing CABG may lead to the development of strategies to minimize the risk.
MedicalResearch.com: Is there anything else you would like to add?
Response: We would like to acknowledge that this study was supported by a Partnerships for Research and Innovation in the Health System (PRIHS) award from Alberta Innovates – Health Solutions (AIHS). We used data from Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Severe Obesity Is Associated With Increased Risk of Early Complications and Extended Length of Stay Following Coronary Artery Bypass Grafting Surgery
J Am Heart Assoc.2016; 5: e003282
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