Obesity is a major public health problem in the United States, afflicting more than 30 percent of the general population. It is a major contributor to a host of diseases and disorders, including heart disease, the nation's leading killer. Many obese patients are in need of cardiac surgery, yet some have been denied such therapy because their weight is viewed as an obstacle to recovery. But in an article in a recent issue of Circulation, School of Medicine researchers conclude that not even severe obesity affects recovery from open-heart surgery.
"Contrary to what a lot of medical professionals believe, there does not appear to be a significantly increased risk in performing cardiac surgery on obese patients," said Michael J. Moulton, M.D., research associate in cardiothoracic surgery and lead author of the study. "Our data show that surgery is indeed a reasonable option."
The group performed a comparative study of the outcome of 2,299 patients who had undergone cardiopulmonary bypass surgery. Of the research population, 567 were classified as obese or severely obese. The researchers observed slightly higher rates of infection and a common postoperative arrhythmia in the overweight population, but the mortality rates were very similar -- 4.6 percent in the obese group vs. 4.3 percent in the nonobese group.
"That's not significant when one considers the host of potential complications for open-heart surgery," Moulton said. "The obese patients had very similar rates of complications in cardiac surgery as those who were not obese. Even those most afflicted by their weight had no expected increase in serious perioperative morbidity or mortality."
In their analysis, the researchers focused on pulmonary lung complications and kidney disorders. "It was often thought that obese heart-surgery patients would experience more pneumonia and other pulmonary problems, but we didn't find that at all," Moulton said. "It also has been speculated that, because of the longer and more complex cardiopulmonary bypass run in overweight patients, there would be more renal problems after surgery. But we didn't find that either."
The obese patients even required less intensive care and hospitalization. Their length of stay in the intensive-care unit ranged from 4.4 to 6.0 days compared with 5.7 to 9.0 days for the nonobese population. Total length of stay was between 11.8 and 12.6 days for the obese patients and 14.9 and 18.3 days for the nonobese patients.
The study did reveal an increase in postoperative infection in the obese population. But surgeons have known for some time that overweight patients are more prone to wound infections in the wake of surgery.
The obese patients also were more likely to develop a common form of atrial arrhythmia. However, approximately one-third of all cardiac-surgery patients experience this same condition due to the trauma of opening the chest.
"Surgery for these patients has been viewed as inappropriate," Moulton said. "We know that they have significantly higher rates of heart disease, but the choice of treatment should not be influenced solely by their weight. I think there's certainly a bias among some health-care providers who care for these patients, and there's a whole other issue with insurance providers."
Though more research is necessary, particularly prospective studies of obese cardiac-surgery patients, Moulton is confident that health-care and insurance providers will heed the initial findings.
"Overall, I think these patients do just fine, and we should not deny them surgery," Moulton said. "The study demonstrates that heart surgery is just as appropriate for them as for nonobese patients."
-- George Corsiglia
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