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Post–Cardiac Surgery ICU Usage Rises With Increasing Obesity

The growing proportion of severely obese cardiac-surgery patients is going to place increasing strain on healthcare resources, as they are more likely to require intensive care unit (ICU) services and have longer recovery times than other patients, suggest the results of a US study.

The research, which was published online in the Annals of Thoracic Surgery on August 9, show that the most obese patients are substantially more likely than other cardiac-surgery patients to have a prolonged ICU stay, to require ventilation, and to be readmitted to the ICU.

"We saw that, as patients became more obese, the hospital resources required to care for them after heart surgery also increased," commented lead author Brandon R Rosvall, department of cardiac surgery, New Brunswick Heart Centre, Saint John Regional Hospital, New Brunswick, in a press release.

Noting that more efficient use of ICU resources could not only save healthcare dollars but also improve overall patient care, he said that knowing that obese patients — the prevalence of which increased over the study period — spend more time in the ICU postoperatively than others could be used to better predict ICU bed vacancies and plan staff scheduling.

Mr Rosvall also suggested that, to help reduce reliance on the ICU, doctors could monitor obese patients more closely and have discussions preoperatively about the particular surgical risks they may face.

 "Patients should be aware that obesity may negatively impact recovery from heart surgery. More in-depth conversations regarding surgical risks and alternatives to surgery should take place with obese patients so that they are aware of the true impact of increased obesity," he said.

"While obesity has become a social issue, it is one that can be addressed on a personal level. By working with their healthcare providers, patients can learn how to achieve and maintain a healthy body weight."

One of First Analyses of Impact of Obesity on Post–Cardiac Surgery ICU Use

While there have been several studies on the impact of obesity on mortality and complication rates following cardiac surgery, there have been few analyses on the effect of obesity of the use of postoperative ICU resources, with those that have been conducted yielding conflicting results.

The researchers therefore carried out a retrospective analysis in which they stratified all cardiac-surgery patients with a body mass index (BMI) of =18.5 kg/m2 treated at a single institution between 2006 and 2013 into the following groups:

•  Normal: BMI 18.5–24.99 kg/m2.

•  Preobese: BMI 25–29.99 kg/m2.

•  Obese class I: BMI 30–34.99 kg/m2.

•  Obese class II: BMI 35–39.99 kg/m2.

•  Obese class III: BMI =40 kg/m2.

Among 5365 patients treated over the study period, 1178 (22%) were classified as normal weight, 2239 (42%) as preobese, and 1948 (36%) as obese.

Among the obese, 1363 (25% of total patients) had class I obesity, 441 (8%) were class II, and 144 (3%) were classed as grade III obese.

There was a significance increase in the prevalence of obesity over the study period, from 33% in 2006 to 38% in 2013 (= .02), with the largest increase seen in obesity class III, from 1.0% to 3.8% (< .0001).

A higher BMI was linked to higher preoperative rates of smoking and New York Heart Association class 4 heart-failure symptoms and was inversely associated with patient age and the proportion of patients with a left ventricular ejection fraction <40%.

Obese class III patients were more likely than other patients to undergo isolated valve procedures, while those in obese class I or lower groups were more likely to have combined coronary artery bypass grafting/valve procedures than other patients.

The median length of hospital stay (LOS) was 5 days (interquartile range, 47 days), and the overall postoperative in-hospital mortality rate was 1.7%.

Obese patients were more likely than others to die in the hospital or have a prolonged ICU stay and ventilation, ICU readmission, longer LOS, and discharge with home care.

Multivariable logistic regression modeling revealed that, after adjustment, greater obesity was associated with an increased risk of prolonged ICU stay, at an odds ratio of 2.4 for obese class II patients and 4.1 for obese class III patients.

Increased obesity was also associated with an increased risk of prolonged ventilation, at an odds ratio of 3.4 for obese class III patients, and ICU readmission, at an odds ratio of 3.0 for obese class II patients and 2.9 for obese class III patients.

The team writes: "In patients undergoing cardiac operations, increasing obesity was associated with a significant increase in ICU resource utilization.

"Further study is required to determine mechanisms underlying this association and how the deleterious effect of obesity may be reduced to optimize healthcare efficiency among obese patients undergoing cardiac operations."

Post–Cardiac Surgery ICU Usage Rises With Increasing Obesity - Medscape - Aug 17, 2017.


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