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 Strauss; Harindra C. Wijeysundera; Frank W. Smart; Eldad Erez; Ronny Alcalai; David Planer; Offer Amir

doi:10.3389/fcvm.2021.754934

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 Strauss, Harindra C. Wijeysundera, Frank W. Smart, Eldad Erez, Ronny Alcalai, David Planer, Offer Amir

Bar-Ilan University - Azrieli Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

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/m²) 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/m² and in patients with BMI ≥40 kg/m² compared to patients with BMI 20–39 kg/m². In the multivariable regression model, BMI subgroups of ≤19 kg/m² and ≥40 kg/m² 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.

Original language	English
Article number	754934
Journal	Frontiers in Cardiovascular Medicine
Volume	8
DOIs	https://doi.org/10.3389/fcvm.2021.754934
State	Published - 2021

Bibliographical note

Publisher Copyright:
Copyright © 2021 Elbaz-Greener, Rozen, Carasso, Kusniec, Yarkoni, Marai, Strauss, Wijeysundera, Smart, Erez, Alcalai, Planer and Amir.

Funding

The GE-G affirms that she has listed everyone who contributed significantly to the work, had access to all the study data, takes responsibility for the accuracy of the analysis, and had authority over the manuscript preparation and the decision to submit the manuscript for publication, and confirms that all authors read and approved the manuscript.

Keywords

body mass index (BMI)
coronary artery bypass grafting surgery (CABG)
ischemic heart
mortality
outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/fcvm.2021.754934

Cite this

Elbaz-Greener, G., Rozen, G., Carasso, S., Kusniec, F., Yarkoni, M., Marai, I., Strauss, B., Wijeysundera, H. C., Smart, F. W., Erez, E., Alcalai, R., Planer, D., & Amir, O. (2021). The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery. Frontiers in Cardiovascular Medicine, 8, Article 754934. https://doi.org/10.3389/fcvm.2021.754934

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

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/m2) 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/m2 and in patients with BMI ≥40 kg/m2 compared to patients with BMI 20–39 kg/m2. In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 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.",

keywords = "body mass index (BMI), coronary artery bypass grafting surgery (CABG), ischemic heart, mortality, outcome",

author = "Gabby Elbaz-Greener and Guy Rozen and Shemy Carasso and Fabio Kusniec and Merav Yarkoni and Ibrahim Marai and Bradley Strauss and Wijeysundera, {Harindra C.} and Smart, {Frank W.} and Eldad Erez and Ronny Alcalai and David Planer and Offer Amir",

note = "Publisher Copyright: Copyright {\textcopyright} 2021 Elbaz-Greener, Rozen, Carasso, Kusniec, Yarkoni, Marai, Strauss, Wijeysundera, Smart, Erez, Alcalai, Planer and Amir.",

year = "2021",

doi = "10.3389/fcvm.2021.754934",

language = "אנגלית",

volume = "8",

journal = "Frontiers in Cardiovascular Medicine",

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Elbaz-Greener, G, Rozen, G, Carasso, S, Kusniec, F, Yarkoni, M, Marai, I, Strauss, B, Wijeysundera, HC, Smart, FW, Erez, E, Alcalai, R, Planer, D & Amir, O 2021, 'The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery', Frontiers in Cardiovascular Medicine, vol. 8, 754934. https://doi.org/10.3389/fcvm.2021.754934

TY - JOUR

T1 - The Relationship Between Body Mass Index and In-Hospital Mortality in Patients Following Coronary Artery Bypass Grafting Surgery

AU - Elbaz-Greener, Gabby

AU - Rozen, Guy

AU - Carasso, Shemy

AU - Kusniec, Fabio

AU - Yarkoni, Merav

AU - Marai, Ibrahim

AU - Strauss, Bradley

AU - Wijeysundera, Harindra C.

AU - Smart, Frank W.

AU - Erez, Eldad

AU - Alcalai, Ronny

AU - Planer, David

AU - Amir, Offer

PY - 2021

Y1 - 2021

N2 - 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/m2) 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/m2 and in patients with BMI ≥40 kg/m2 compared to patients with BMI 20–39 kg/m2. In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 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.

AB - 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/m2) 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/m2 and in patients with BMI ≥40 kg/m2 compared to patients with BMI 20–39 kg/m2. In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 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.

KW - body mass index (BMI)

KW - coronary artery bypass grafting surgery (CABG)

KW - ischemic heart

KW - mortality

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

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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