Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T05:21:34.467Z Has data issue: false hasContentIssue false
  • English
  • Français

Does obesity affect the short-term outcomes after cardiothoracic surgery in adolescents with congenital heart disease?

Published online by Cambridge University Press:  09 January 2020

Richard U. Garcia Open the ORCID record for Richard U. Garcia [Opens in a new window] ,
Preetha L. Balakrishnan  and
Sanjeev Aggarwal
Richard U. Garcia*
Affiliation:
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine 3901 Beaubien Blvd, Detroit, MI48201-2119, USA
Preetha L. Balakrishnan
Affiliation:
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine 3901 Beaubien Blvd, Detroit, MI48201-2119, USA
Sanjeev Aggarwal
Affiliation:
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine 3901 Beaubien Blvd, Detroit, MI48201-2119, USA
*
Author for correspondence: R. U. Garcia, MD, Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI48201-2119, USA. Tel: +1(313) 966-7277 (Business); Fax: +1(313) 993-0894; E-mail: rgarcias@dmc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Obesity is a modifiable, independent risk factor for mortality and morbidity after cardiovascular surgery in adults. Our objective was to evaluate the impact of obesity on short-term outcomes in adolescents undergoing surgery for congenital heart disease (CHD).

Methods:

This retrospective chart review included patients 10–18 years of age who underwent CHD surgery. Our exclusion criteria were patients with a known genetic syndrome, heart transplantation, and patients with incomplete medical records. The clinical data collected included baseline demographics and multiple perioperative variables. Charting the body mass index in the Centers for Disease Control and Prevention growth curves, the entire cohort was divided into three categories: obese (>95th percentile), overweight (85th–95th percentile), and normal weight (<85th percentile). The composite outcome included survival, arrhythmias, surgical wound infection, acute neurologic injury, and acute kidney injury.

Results:

The study cohort (n = 149) had a mean standard deviation (SD), body mass index (BMI) of 22.6 ± 6.5 g/m2, and 65% were male. There were 27 obese (18.1%), 24 overweight (16.1%), and 98 normal weight (65.8%) patients. Twenty-seven (18%) patients had composite adverse outcomes. Overweight and obese patients had significantly higher adverse outcomes compared with normal weight patients (odds ratio (OR): 2.9; confidence interval (CI): 1–8.5, p = 0.04 and OR: 3; CI: 1–8.5, p = 0.03, respectively). In multivariate analysis, obesity was an independent predictor of adverse outcome in our cohort (p = 0.04).

Conclusions:

Obesity is associated with short-term adverse outcome and increased health resource utilisation in adolescents following surgery for CHD. Further studies should evaluate if intervention in the preoperative period can improve outcomes in this population.

Keywords

Obesitypost-operative outcomescongenital heart diseaseadolescents
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 3 , March 2020 , pp. 372 - 376
Copyright
© Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hales, CM, Carroll, MD, Fryar, CD, Ogden, CL.Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief 2017 Oct: 1–8.Google ScholarPubMed
Collaborators, GBDO, Afshin, A, Forouzanfar, MH, et al.Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017; 377: 13–27.CrossRefGoogle Scholar
Daniels, SR.Complications of obesity in children and adolescents. Int J Obes (Lond) 2009; 33: S60–S65.CrossRefGoogle ScholarPubMed
Ray, TD, Green, A, Henry, K.Physical activity and obesity in children with congenital cardiac disease. Cardiol Young 2011; 21: 603–607.CrossRefGoogle ScholarPubMed
Tamayo, C, Manlhiot, C, Patterson, K, Lalani, S, McCrindle, BW.Longitudinal evaluation of the prevalence of overweight/obesity in children with congenital heart disease. Can J Cardiol 2015; 31: 117–123.CrossRefGoogle ScholarPubMed
Goh, VL, Wakeham, MK, Brazauskas, R, Mikhailov, TA, Goday, PS.Obesity is not associated with increased mortality and morbidity in critically ill children. J Parenter Enteral Nutr 2013; 37: 102–108.CrossRefGoogle Scholar
Brown, CV, Neville, AL, Salim, A, Rhee, P, Cologne, K, Demetriades, D.The impact of obesity on severely injured children and adolescents. J Pediatr Surg 2006; 41: 88–91; discussion 88–91.CrossRefGoogle ScholarPubMed
Ross, PA, Newth, CJ, Leung, D, Wetzel, RC, Khemani, RG.Obesity and mortality risk in critically ill children. Pediatrics 2016; 137: e20152035.CrossRefGoogle ScholarPubMed
Buelow, MW, Earing, MG, Hill, GD, et al.The impact of obesity on postoperative outcomes in adults with congenital heart disease undergoing pulmonary valve replacement. Congenit Heart Dis 2015; 10: E197–E202.CrossRefGoogle ScholarPubMed
O’Byrne, ML, Kim, S, Hornik, CP, et al.Effect of obesity and underweight status on perioperative outcomes of congenital heart operations in children, adolescents, and young adults: an analysis of data from the society of thoracic surgeons database. Circulation 2017; 136: 704–718.CrossRefGoogle Scholar
Barlow, SE, Expert, C.Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120: S164–S192.10.1542/peds.2007-2329CCrossRefGoogle ScholarPubMed
Kelly, AS, Barlow, SE, Rao, G, et al.Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128: 1689–1712.CrossRefGoogle ScholarPubMed
Lex, DJ, Toth, R, Cserep, Z, et al.A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg 2014; 97: 202–210.CrossRefGoogle ScholarPubMed
O’Brien, SM, Clarke, DR, Jacobs, JP, et al.An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 1139–1153.CrossRefGoogle ScholarPubMed
Ogden, CL, Carroll, MD, Kit, BK, Flegal, KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 2012; 307: 483–490.CrossRefGoogle Scholar
Shamszad, P, Rossano, JW, Marino, BS, Lowry, AW, Knudson, JD.Obesity and diabetes mellitus adversely affect outcomes after cardiac surgery in children’s hospitals. Congenit Heart Dis 2016; 11: 409–414.CrossRefGoogle ScholarPubMed
Singer, K, Eng, DS, Lumeng, CN, Gebremariam, A, M Lee, J. The relationship between body fat mass percentiles and inflammation in children. Obesity 2014; 22: 1332–1336.CrossRefGoogle ScholarPubMed
Train, AT, Cairo, SB, Meyers, HA, Harmon, CM, Rothstein, DH.The impact of obesity on 30-day complications in pediatric surgery. Pediatr Surg Int 2017; 33: 1167–1175.CrossRefGoogle ScholarPubMed
Kabon, B, Nagele, A, Reddy, D, et al.Obesity decreases perioperative tissue oxygenation. Anesthesiology 2004; 100: 274–280.CrossRefGoogle ScholarPubMed
Sen, CK.Wound healing essentials: let there be oxygen. Wound Repair Regen 2009; 17: 1–18.CrossRefGoogle ScholarPubMed
Falagas, ME, Karageorgopoulos, DE.Adjustment of dosing of antimicrobial agents for bodyweight in adults. Lancet 2010; 375: 248–251.CrossRefGoogle ScholarPubMed
Martin, JH, Saleem, M, Looke, D.Therapeutic drug monitoring to adjust dosing in morbid obesity - a new use for an old methodology. Br J Clin Pharmacol 2012; 73: 685–690.CrossRefGoogle ScholarPubMed
O’Byrne, ML, McBride, MG, Paridon, S, Goldmuntz, E.Association of habitual activity and body mass index in survivors of congenital heart surgery: a study of children and adolescents with tetralogy of fallot, transposition of the great arteries, and fontan palliation. World J Pediatr Congenit Heart Surg 2018; 9: 177–184.CrossRefGoogle ScholarPubMed