Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery? The Influence of Body Mass Index on Outcomes in Patients Undergoing Cardiac Surgery: Does the Obesity Paradox Really Exist? Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Obesity paradox in patients with hypertension and coronary artery disease. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. The impact of body mass index on short- and long-term outcomes inpatients undergoing coronary revascularization. Insights from the bypass angioplasty revascularization investigation (BARI). The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin☆☆☆★ [Consequences of obesity in outcomes after cardiac surgery. Analysis of ARIAM registry]. Obesity and outcomes among patients with established atrial fibrillation. Obesity paradox in coronary artery bypass grafting: myth or reality? "Obesity paradox" in chronic obstructive pulmonary disease. Two-year changes in generic and obesity-specific quality of life after gastric bypass The obesity paradox in surgical intensive care unit patients Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. Increased exercise capacity after surgically induced weight loss in morbid obesity. Impact of Body Mass Index on Perioperative Outcomes in Patients Undergoing Major Intra-abdominal Cancer Surgery
INTRODUCTION Obesity has been described as a risk factor for the development of coronary artery disease , but it has not been determined whether obesity is associated with adverse outcomes after cardiac surgery . Therefore , we analyzed a large cohort of patients who had undergone cardiac surgery to determine whether obesity is a predictor of mortality , morbidity or early readmission to hospital . METHODS At the London Health Sciences Centre , an academic tertiary care centre , we prospect ively entered data from the cardiac surgical data base from July 1999 to April 2002 . We collected data on 1310 consecutive , unselected patients who underwent cardiac surgery during that time . We assessed the degree of obesity using the body mass index ( BMI ) , and we prospect ively documented the occurrence of 10 major complications after surgery . They included stroke , reoperation for bleeding , life-threatening cardiac arrest or arrhythmia , new renal failure requiring dialysis , septicemia , mediastinitis , sternal dehiscence , respiratory failure , postoperative myocardial infa rct ion and low cardiac output necessitating intra-aortic balloon pump use . Univariable and multivariable analyses were conducted to determine the factors associated with and predictive of postoperative death and major complications . RESULTS An increased BMI did not increase the risk of early postoperative death . Furthermore , increased BMI was not a predictor of a patient experiencing any of the major complications , except sternal dehiscence . An increased BMI was associated with a higher likelihood of readmission to hospital within 30 days of discharge . CONCLUSION Obesity was not associated with adverse outcomes after cardiac operations , aside from the increased risks of sternal dehiscence and early hospital readmission Purpose Obesity influences risk stratification in cardiac surgery in everyday practice . However , some studies have reported better outcomes in patients with a high body mass index ( BMI ): this is known as the obesity paradox . The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery , and to assess the existence of an obesity paradox in our patients . Methods A total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospect ively studied at our institution . Patients were divided into four groups based on BMI : normal weight ( 18.5–24.9 kg∙m−2 ; n = 523 ; 21.4 % ) , overweight ( 25–29.9kg∙m−2 ; n = 1150 ; 47 % ) , obese ( ≥30–≤34.9kg∙m−2 ; n = 624 ; 25.5 % ) and morbidly obese ( ≥35kg∙m−2 ; n = 152 ; 6.2 % ) . Follow-up was performed in 2,379 patients during the first year . Results After adjusting for confounding factors , patients with higher BMI presented worse oxygenation and better nutritional status , reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48h after admission respectively . Obese patients showed a higher risk for Perioperative Myocardial Infa rct ion ( OR : 1.768 ; 95 % CI : 1.035–3.022 ; p = 0.037 ) and septicaemia ( OR : 1.489 ; 95 % CI : 1.282–1.997 ; p = 0.005 ) . In-hospital mortality was 4.8 % ( n = 118 ) and 1-year mortality was 10.1 % ( n = 252 ) . No differences were found regarding in-hospital mortality between BMI groups . The overweight group showed better 1-year survival than normal weight patients ( 91.2 % vs. 87.6 % ; Log Rank : p = 0.029 . HR : 1.496 ; 95 % CI : 1.062–2.108 ; p = 0.021 ) . Conclusions In our population , obesity increases Perioperative Myocardial Infa rct ion and septicaemia after cardiac surgery , but does not influence in-hospital mortality . Although we found better 1-year survival in overweight patients , our results do not support any protective effect of obesity in patients undergoing cardiac surgery BACKGROUND Obesity has become a public health crisis . Although prior studies in obese patients undergoing cardiac surgical procedures have shown variable effects on outcomes , data are limited for extremely obese patients ( body mass index [ BMI ] > or = 45 ) . We undertook this study to evaluate outcomes in this cohort . METHODS A retrospective analysis was performed on 14,571 patients in our data base who underwent cardiac operations from 1992 to 2005 . Patient demographics , comorbidities , and outcomes were recorded . A univariate analysis between two groups : BMI 21 to 34.9 and BMI 45 or more was performed . Logistic regression models were used to identify independent risk factors for 30-day mortality . Long-term follow-up of the extreme obese group was achieved . RESULTS We identified 128 extreme obese patients , and 480 patients with a BMI of 21.0 to 34.9 were r and omly selected for comparison . Univariate analysis showed significant differences in age , gender , and multiple comorbidities , as well as in cardiopulmonary bypass and cross-clamp times , operative procedure , and transfusion requirements . Extreme obese patients had a higher incidence of infection , acute renal failure , and 30-day mortality . Logistic regression analysis showed BMI , preoperative renal insufficiency , and transfusion status to be independent risk factors for 30-day mortality . Follow-up data did not reveal significant functional improvements . Long-term survival was 33.6 % at 12 years . CONCLUSIONS Extreme obese patients undergoing cardiac surgical procedures have higher perioperative morbidity and mortality compared with a lower BMI group . BMI and preoperative renal insufficiency increase mortality in both groups , whereas transfusion does so only in the extreme obese . These patients can realize acceptable outcomes from cardiac procedures , but continue to suffer from the comorbidities of obesity PURPOSE An obesity paradox , a " paradoxical " decrease in morbidity and mortality with increasing body mass index ( BMI ) , has been shown in patients with heart failure and those undergoing percutaneous coronary intervention . However , whether this phenomenon exists in patients with hypertension and coronary artery disease is not known . METHODS A total of 22,576 hypertensive patients with coronary artery disease ( follow-up 61,835 patient years , mean age 66+/-9.8 years ) were r and omized to a verapamil-SR or atenolol strategy . Dose titration and additional drugs ( tr and olapril and /or hydrochlorothiazide ) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure targets . Patients were classified into 5 groups according to baseline BMI : less than 20 kg/m2 ( thin ) , 20 to 25 kg/m2 ( normal weight ) , 25 to 30 kg/m2 ( overweight ) , 30 to 35 kg/m2 ( class I obesity ) , and 35 kg/m2 or more ( class II-III obesity ) . The primary outcome was first occurrence of death , nonfatal myocardial infa rct ion , or nonfatal stroke . RESULTS With patients of normal weight ( BMI 20 to<25 kg/m2 ) as the reference group , the risk of primary outcome was lower in the overweight patients ( adjusted hazard ratio [ HR ] 0.77 , 95 % confidence interval [ CI ] , 0.70 - 0.86 , P<.001 ) , class I obese patients ( adjusted HR 0.68 , 95 % CI , 0.59 - 0.78 , P<.001 ) , and class II to III obese patients ( adjusted HR 0.76 , 95 % CI , 0.65 - 0.88 , P < .001 ) . Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months ( -17.5+/-21.9 mm Hg/-9.8+/-12.4 mm Hg vs -20.7+/-23.1 mm Hg /-10.6+/-12.5 mm Hg , P<.001 ) . CONCLUSION In a population with hypertension and coronary artery disease , overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight , which was driven primarily by a decreased risk of all-cause mortality . Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention BACKGROUND A debate exists whether obesity is a risk factor for operative mortality after  coronary artery bypass graft surgery ( CABG ) . The contradictory findings in the literature may largely be attributable to the variety of method ological approaches used to model the association between body mass index ( BMI ) and post-CABG outcomes . This study aims to investigate this association , and to uncover possible explanations for the lack of consensus across prior studies . METHODS Data were prospect ively collected on 80,792 patients who underwent a CABG procedure during a 14-year period at the 45 Department of Veterans Affairs cardiac surgery programs .  Generalized additive models were used to estimate the relationship of BMI and outcomes after a CABG procedure . RESULTS We found that the relationship of BMI with post-CABG mortality and morbidity is U-shaped with the minimum risk located around a BMI of 30 kg/m2 , indicating that patients classified as overweight have the lowest risk , and those in the lower end of the obese range do not have seriously elevated risk . This U-shape relationship is significantly nonlinear and robust to adjustment for other risk factors . CONCLUSIONS This study demonstrates that BMI is an independent predictor of mortality and morbidity after CABG surgery . Previous studies that model BMI linearly or as categories can not accurately capture this U-shaped relationship and are unlikely to find a significant contribution by including BMI . Further research is needed to determine the mechanisms of risk for patients with low and high BMI and whether interventions to modify BMI may improve patient outcomes OBJECTIVES This study sought to define the relationship between  body mass index ( BMI )  and mortality in heart failure ( HF ) across the world and to identify specific groups in whom BMI may differentially mediate risk . BACKGROUND Obesity is associated with incident HF , but it is paradoxically associated with better prognosis during chronic HF . METHODS We studied 6,142 patients with acute decompensated HF from 12 prospect i ve observational cohorts followed-up across 4 continents . Primary outcome was all-cause mortality . Cox proportional hazards models and net reclassification index described associations of BMI with all-cause mortality . RESULTS Normal-weight patients ( BMI 18.5 to 25 kg/m(2 ) ) were older with more advanced HF and lower cardiometabolic risk . Despite worldwide heterogeneity in clinical features across obesity categories , a higher BMI remained associated with decreased 30-day and 1-year mortality ( 11 % decrease at 30 days ; 9 % decrease at 1 year per 5 kg/m(2 ) ; p < 0.05 ) , after adjustment for clinical risk . The BMI obtained at index admission provided effective 1-year risk reclassification beyond current markers of clinical risk ( net reclassification index 0.119 , p < 0.001 ) . Notably , the " protective " association of BMI with mortality was confined to persons with older age ( > 75 years ; hazard ratio [ HR ] : 0.82 ; p = 0.006 ) , decreased cardiac function ( ejection fraction < 50 % ; HR : 0.85 ; p < 0.001 ) , no diabetes ( HR : 0.86 ; p < 0.001 ) , and de novo HF ( HR : 0.89 ; p = 0.004 ) . CONCLUSIONS A lower BMI is associated with age , disease severity , and a higher risk of death in acute decompensated HF . The " obesity paradox " is confined to older persons , with decreased cardiac function , less cardiometabolic illness , and recent-onset HF , suggesting that aging , HF severity/chronicity , and metabolism may explain the obesity paradox OBJECTIVES We sought to investigate the impact of body mass index ( BMI ) on short- and long-term outcomes after initial revascularization with percutaneous transluminal coronary angioplasty ( PTCA ) or coronary artery bypass graft surgery ( CABG ) .  BACKGROUND Equivocal results exist on the impact of BMI on the risk of in-hospital complications after PTCA or CABG , and no long-term mortality data exist from a large series of revascularized patients . METHODS From the r and omized series and observational registry of the Bypass Angioplasty Revascularization Investigation ( BARI ) , 2,108 patients who had PTCA and 1,526 patients who had CABG were evaluated by taking their BMI at study entry . They were classified as follows : low ( < 20 kg/m(2 ) ) , normal ( 20 to 24.9 kg/m(2 ) ) , overweight ( 25 to 29.9 kg/m(2 ) ) , class I obese ( 30 to 34.9 kg/m(2 ) ) and class II/III obese ( greater-than-or-equal 35 kg/m(2 ) ) . In-hospital complications and short- and long-term mortalities were compared between levels of BMI within each mode of initial revascularization . RESULTS Among patients who had PTCA , each unit increase in BMI was associated with a 5.5 % lower adjusted risk of a major in-hospital event ( death , myocardial infa rct ion , stroke , coma ) ; among patients who had CABG , no difference in the in-hospital outcome was observed according to BMI . In contrast , BMI was not associated with five-year mortality in the PTCA group ; among the CABG group , adjusted relative risks of five-year cardiac mortality according to levels of BMI were 0.0 ( low ) , 1.0 ( normal ) , 2.02 ( overweight ) , 3.16 ( class I obese ) and 4.85 ( class II/III obese ) ( linear p < 0.001 ) . CONCLUSIONS Body mass index appears to have a differential impact on short- and long-term outcomes after coronary revascularization . These results underscore the need for further research to identify factors responsible for the apparent short-term protective effect of a higher BMI in patients undergoing PTCA and to study the impact of weight reduction on the long-term survival of obese patients undergoing CABG Aims We have investigated the role of muscle mass , natriuretic peptides and adipokines in explaining the obesity paradox . Background The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease ( CHD ) or heart failure ( HF ) . Methods Prospect i ve study of 4046 men aged 60–79 years followed up for a mean period of 11 years , during which 1340 deaths occurred . The men were divided according to the presence of doctor diagnosed CHD and HF : ( i ) no CHD or HF ii ) , with CHD ( no HF ) and ( iii ) with HF . Results Overweight ( BMI 25–9.9 kg/m2 ) and obesity ( BMI ≥ 30 kg/m2 ) were associated with lower mortality risk compared to men with normal weight ( BMI 18.5–24.9 kg/m2 ) in those with CHD [ hazards ratio ( HR ) 0.71 ( 0.56,0.91 ) and 0.77 ( 0.57,1.04 ) ; p = 0.04 for trend ] and in those with HF [ HR 0.57 ( 0.28,1.16 ) and 0.41 ( 0.16,1.09 ; p = 0.04 for trend ) . Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD ( no HF ) [ HR 0.78 ( 0.61,1.01 ) and 0.96 ( 0.68,1.36 ) p = 0.60 for trend ) but made minor differences to those with HF [ p = 0.05 ] . Leptin related positively to mortality in men without HF but inversely to mortality in those with HF ; adjustment for leptin abolished the BMI mortality association in men with HF [ HR 0.82 ( 0.31,2.20 ) and 0.99 ( 0.27,3.71 ) ; p = 0.98 for trend ] . Conclusion The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass . In men with HF , leptin ( possibly reflecting cachexia ) explain the inverse association BACKGROUND AND OBJETIVE Obesity is a disease that affects a large part of the population and has been associated with worse outcomes after cardiac surgery . The aim of our study is to evaluate the consequences of obesity related to postoperative complications , hospital length of stay and mortality . METHODS Observational , prospect i ve , multicenter study of patients included in ARIAM registry of adult cardiac surgery between March 2008 to March 2011 . We analyzed clinical variables , the surgical procedure , postoperative complications and mortality , comparing the group of patients with body mass index ( BMI ) greater or less than 30 kg/m(2 ) . RESULTS The study included 4,172 patients with a mean age of 64.03 ( SD 12.08 ) years , BMI 28.53 ( 4.7 ) and EuroSCORE 5.58 ( 2.91 ) . In 1,490 patients ( 35.7 % ) BMI was greater than 30 . There were no differences in the development of overall postoperative complications ( 33 % in obese and non-obese 35.8 % , P=.07 ) , although there were less appreciated reoperation rate or stroke ( P<.05 ) , as well as further development postoperative renal failure ( P=.009 ) . After adjusting for severity and length of cardio by pass time , obese patients had lower mortality without being statistically significant . OR 0.94 ( 0.79 - 1.04 ) . There were no differences in ICU length of stay , but obese patients had greater Ward length of stay 9.04 ( 10.43 ) vs. 8.18 ( 9.2 ) days , P=.01 . CONCLUSIONS Obese patients undergoing cardiac surgery have a mortality , rate of complications and length of stay similar to non-obese . Obese patients required less reoperations but developed more frequently postoperative renal failure Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy OBJECTIVE A high body mass index has been suggested to be protective in patients with coronary artery disease and in those undergoing coronary artery bypass grafting ( CABG ) .  However , these conflicting results might be related to the different risk profiles among the various body mass index categories . We sought to clarify the effect of varying degrees of excessive body weight on hard clinical outcomes in patients undergoing CABG .  METHODS A retrospective analysis of prospect ively collected data was conducted to investigate the effect of a high body mass index on early and late mortality after  first-time isolated CABG . Propensity score matching was used to adjust for confounding factors . RESULTS The study sample consisted of 3269 normal weight , 6662 overweight , 3821 obese , and 211 morbidly obese patients . After matching , early mortality was not affected by overweight ( mean difference , 0.7 % ; 95 % confidence interval [ CI ] , -0.2 % to 1.5 % ) , obesity ( mean difference , 0.5 % ; 95 % CI , -0.7 % to 1.7 % ) , and morbid obesity ( mean difference , 1.6 % ; 95 % CI , -1.0 % to 1.0 % ) , regardless of the patients ' risk profile according to the European system for cardiac operative risk evaluation . Overweight status was not protective for late death ( hazard ratio , 1.05 ; 95 % CI , 0.9 - 1.08 ; P = .4 ) . Compared with normal weight patients , both obese and morbidly obese patients had a higher risk of late death ( hazard ratio , 1.22 ; 95 % CI , 1.07 - 2.66 ; P = .006 for obese patients ; hazard ratio , 1.36 ; 95 % CI , 0.74 - 2.49 ; P = .3 for morbidly obese patients ) . CONCLUSIONS Obesity did not increase operative mortality , but it was associated with reduced late survival in patients undergoing primary isolated CABG . Our results raise concerns in supporting any protective effect of obesity in cardiovascular disease , specifically in patients undergoing surgical myocardial revascularization BACKGROUND The " obesity paradox " is defined as an inverse association of good health , survival and obesity . Usually in healthy persons the more obese you are the more metabolic complications you have ; however , thin patients with chronic obstructive pulmonary disease ( COPD ) have more cardiovascular complications and a higher mortality rate . OBJECTIVES To explore whether atherosclerosis and peripheral artery disease ( PAD ) contribute to the higher morbidity and mortality of patients with COPD . METHODS This prospect i ve study included 87 patients with chronic COPD who were treated in the pulmonary outpatient clinic ; all signed a consent form before enrollment . We documented their  lung function ( FEV1 % ) , body mass index ( BMI ) and ankle brachial index ( ABI ) . The primary endpoints were to find an association between atherosclerosis and BMI in patients with COPD , and between atherosclerosis and severity of lung disease . RESULTS Average ABI was 1.01 + /- 0.20 , BMI was 29.33 + /- 7.48 kg/m2 , and the abdominal circumference was 107.34 + /- 18.87 cm . A positive correlation was found between BMI and ABI ( P=0.001 ) and between abdominal circumference and ABI ( P=0.000 ) . Patients with peripheral artery disease were older ( 73.6 + /- 11.5 vs. 68.1 + /- 11.6 years old , P= 0.04 ) , were thinner ( average BMI 25.5 + /- 6.2 vs. 31.06 + /- 7.3 , P= 0.001 ) , and had a lower abdominal circumference ( 97.7 + /- 18.3 vs. 111.7 + /- 17.5 cm , P=0.001 ) . No such difference was observed for years of smoking . Male PAD patients with COPD had a lower BMI ( 25.2 + /- 5.6 vs. 29.9 + /- 7.4 , P = 0.016 ) , and their abdominal circumference was smaller ( 96.1 + /- 18.0 vs. 110.2 + /- 16.5 cm , P=0.004 ) . Female PAD patients with COPD had a lower BMI ( 26.3 + /- 8.2 vs. 33.1 + /- 7.0 , P=0.045 ) , but their abdominal circumference was not different from females without PAD ( 102.0 + /- 19.7 vs. 114.0 + /- 19.4 cm , P=0.162 ) . Patients with PAD had a worse lung disease ( FEV1 % 34 + /- 8 % vs. 45 + /- 16 % , P=0.01 ) . During the 1 year of follow-up five patients died : two PAD patients due to acute myocardial infa rct ion and three non-PAD patients died from pulmonary insufficiency ( two patients ) and pulmonary emboli ( one patient ) . DISCUSSION We found that COPD patients with PAD were older and thinner and had a lower abdominal circumference and a more progressive lung disease . Extensive atherosclerosis in patients with COPD may partly explain the " obesity paradox " observed in patients with COPD The study objectives were to assess 2-year changes in health-related quality of life ( HRQL ) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery . This was a prospect i ve intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country . We used both generic ( Short Form Health Survey , SF-36 and EuroQol , EQ-5D ) , and specific question naires ( Moorehead-Ardelt , MA II and Obesity-related Problems Scale , OP ) . Effect sizes and receiver operating characteristic ( ROC ) curves were calculated to assess the change in quality of life . Spearman ’s correlation coefficient was calculated to assess whether there was an association between changes in body mass index ( BMI ) and HRQL . Of 82 patients who underwent surgery , 79 were followed-up for 2 years . Mean weight loss was 37 % of body weight ( 49 kg ) and BMI fell from 50.6 to 31.8 . The initial problems and final improvements were greater in the physical dimensions . Considerable benefits were observed in assessment s with all the instruments used . However , the changes in weight/ BMI and HRQL were not linear . The comparison with general population showed a similar profile in SF-36 dimensions after surgery . Severely obese patients have lower perceived health across all dimensions of quality of life . Moreover , the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment . ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI Purpose To investigate the possible impact of obesity , as assessed by body mass index ( BMI ) , on outcome in surgical intensive care unit ( ICU ) patients . Methods Prospect ively collected data from all consecutive adult patients admitted to our ICU between January 2004 and January 2009 were analysed retrospectively . BMI was calculated using the formula : BMI = body weight/height2 ( kg/m2 ) , and patients were grouped as underweight ( < 18.5 kg/m2 ) , normal weight ( 18.5–24.9 kg/m2 ) , overweight ( 25–29.9 kg/m2 ) , obese ( 30–39.9 kg/m2 ) and very obese ( ≥40 kg/m2 ) . Results Among the 12,938 patients who were admitted to our ICU during the study period , 9,935 ( 76.8 % ) had complete height and weight data and constituted the study group .  The mean BMI was 27.1 ± 5.0 kg/m2 . Overall , 34.4 % of the study population had normal BMI , 1.8 % were underweight , 41.2 % were overweight , 20.8 % were obese and 1.8 % were very obese . The ICU mortality rate was similar among BMI subgroups , but hospital mortality was higher in underweight patients than in patients with normal BMI ( 17.8 % versus 11.1 % , P = 0.006 ) . On multivariate Cox regression analysis , being overweight [ hazard ratio ( HR ) 0.86 , 95 % confidence interval ( CI ) 0.74–0.99 , P = 0.047 ] or obese ( HR = 0.83 , 95 % CI = 0.69–0.99 , P = 0.047 ) was independently associated with lower 60-day in-hospital mortality , with normal BMI as the reference category . Risk of death increased in very obese patients , especially after neurosurgical procedures ( HR = 0.3 , 95 % CI = 1.06–8.48 , P = 0.039 ) . Conclusion In this cohort of surgical ICU patients , being overweight or obese was associated with decreased risk of 60-day in-hospital mortality OBJECTIVE The aim of this study was to investigate the predictive value for all-cause and cardiovascular ( CV ) death of anthropometric measurements of abdominal obesity in patients with end-stage renal disease ( ESRD ) . BACKGROUND Surrogate measures of abdominal obesity and segmental fat distribution ( waist circumference and waist/hip ratio [ WHR ] ) are stronger predictors of all-cause and CV death than body mass index ( BMI ) in the general population , but the issue has never been investigated in patients with ESRD . METHODS We performed a prospect i ve cohort study in 537 patients with ESRD ( age 63 + /- 15 years ) . RESULTS In BMI -adjusted Cox models , waist circumference was a direct predictor of all-cause and CV mortality ( p < 0.001 ) , whereas BMI showed an inverse relationship ( p < 0.001 ) with these outcomes . The incidence rates of overall and CV death were maximal in patients with relatively lower BMI scores ( below the median ) and higher waist circumferences ( at least the median ) and minimal in patients with higher BMI scores ( at least the median ) and small waist circumferences ( below the median ) . The prognostic power of waist circumference for all-cause ( hazard ratio [ HR ] [ 10-cm increase ] : 1.23 ; 95 % confidence interval [ CI ] : 1.02 to 1.47 ; p = 0.03 ) and CV mortality ( HR : 1.37 ; 95 % CI : 1.09 to 1.73 ; p = 0.006 ) remained significant after adjustment for CV comorbidities and traditional and emerging risk factors . WHR was found to be related to all-cause ( p = 0.009 ) and CV mortality ( p = 0.07 ) . CONCLUSIONS Abdominal obesity underlies a high risk of all-cause and CV mortality in patients with ESRD . Redefinition of nutritional status by combining the metrics of abdominal obesity and BMI may refine prognosis in the ESRD population OBJECTIVE To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity ( MO ) . RESEARCH METHODS AND PROCEDURES A prospect i ve 1-year follow-up study was carried out , with patients being their own controls . A symptom-limited cardiopulmonary exercise stress test was performed in 31 MO patients ( BMI > 40 kg/m2 ) before and 1 year after undergoing bariatric surgery .  RESULTS At 1 year after surgery , weight was reduced from 146 + /- 33 to 95 + /- 19 kg ( p < 0.001 ) , and BMI went from 51 + /- 4 to 33 + /- 6 kg/m2 ( p < 0.001 ) . After weight loss , obese patients performed each workload with lower oxygen consumption , heart rate , systolic arterial pressure , and ventilatory volume ( p < 0.001 ) . This reduced energy expenditure allowed them to increase the duration of their effort test from 13.8 + /- 3.8 to 21 + /- 4.2 minutes ( p < 0.001 ) . Upon finishing the exercise , MO patients before surgery were able to reach only 83 % of their age-predicted maximal heart rate , and their respiratory exchange ratio was 0.87 + /- 0.06 . After weight loss , those values were 90 % and 1 + /- 0.08 , respectively ( p < 0.01 ) . When we compared the peak O2 pulse corrected by fat free mass before and after surgery , no significant differences between the groups were found . DISCUSSION After surgically induced weight loss , MO patients markedly improved their exercise capacity . This is due to the fact that they were able to perform the external work with lower energy expenditure and also to increase cardiovascular stress , optimizing the use of cardiac reserve . There were no differences in cardiac function before and after surgery Background Obesity is an increasingly common serious chronic health condition . We sought to determine the impact of body mass index ( BMI ) on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery .  Methods A prospect i ve , multi-institutional , risk-adjusted cohort study of patients undergoing major intra-abdominal cancer surgery was performed from the 14 university hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program ( NSQIP ) . Demographic , clinical , and intraoperative variables and 30-day morbidity and mortality were prospect ively collected in st and ardized fashion . Analysis of variance , Bonferroni multiple comparisons of means tests , and multivariable logistic regression analysis were performed . Results We identified 2258 patients who underwent esophagectomy ( n = 29 ) , gastrectomy ( n = 223 ) , hepatectomy ( n = 554 ) , pancreatectomy ( n = 699 ) , or low anterior resection/proctectomy ( n = 753 ) . Patients were stratified by National Institutes of Health (NIH)-defined BMI obesity class , with 573 ( 25.4 % ) patients classified as obese ( BMI > 30 kg/m2 ) . There were no differences in mean work relative value units , total time of operation , or length of stay amongst the BMI classes . After adjusting for other risk factors , obesity was not a risk factor for death or major complications but was a risk factor for wound complications . The risk of postoperative death was greatest in underweight patients ( odds ratio [ OR ] 5.24 ; 95 % confidence interval [ CI ] 1.7–16.2 ) . Conclusion In patients undergoing major intra-abdominal cancer surgery , obesity is not a risk factor for postoperative mortality or major complications . Importantly , underweight patients have a fivefold increased risk of postoperative mortality , perhaps a consequence of their underlying nutritional status
In the present series , overweight and obese patients had similar or slightly lower in-hospital mortality rates after cardiac surgery compared with normal-weight individuals .
Conversely , postoperative complication rates increased with higher BMI levels .
Most studies included in the review showed that overweight and obese patients had at least the same mortality rate as normal-weight patients , or even a lower death risk .
Pooled- data of the meta- analysis provided evidence on the association between higher BMI levels and a lower all-cause in-hospital mortality rate after cardiac surgery
The relationship between higher body mass index ( BMI ) , decreased morbidity and mortality is known as the " obesity paradox " , and has been described in cohorts of patients with hypertension , diabetes , heart failure , coronary and peripheral artery diseases , non-cardiac surgery , and end-stage renal disease .
Here we investigated the relationship between BMI and short-term outcomes after adult cardiac surgery to explore the existence of an obesity paradoxical effect .
A secondary objective was to perform an up date d systematic review to further analyze the association between BMI and 30-day in-hospital mortality after cardiac surgery .