The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery
Gabby Elbaz‐Greener, Guy Rozen, Shemy Carasso, Fabio Kusniec, Merav Yarkoni, Ibrahim Marai, Bradley H. Strauss, Harindra C. Wijeysundera, Frank W. Smart, Eldad Erez, Ronny Alcalai, David Planer, Offer Amir
Abstract
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.