Critical Illness

CI: Body Weight and Outcomes: Cardiovascular Surgery Patients (2007)

Four research studies with patient populations undergoing coronary revascularization surgery were evaluated for this topic. Subjects were primarily adult men (68-72%) with mean ages 61-67. The patient population consisted of patients undergoing cardiac surgeries including revascularization and valve replacement procedures, but gave no measures of illness severity.

• Monitoring and Evaluation
  In critically ill cardiovascular surgical patients, what effect does weight have on mortality?

  • Conclusion
    There is fair evidence that mortality is increased in critically ill cardiovascular surgery patients who have a BMI < 24.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill cardiovascular surgical patients, what effect does weight have on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ, Couper GS, Allred EN, Cohn LH, Rizzo RJ. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 1999;118:866-873.
        
      • Potapov EV, Matthias L, Anker S, Stein J, Bondy S, Naserri BA, Sodian R, Hausmann H and Hetzer R. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. European Heart J. 2003; 24:1933-1941.
      • Ranucci M, Cazzaniga A, Soro G, Morricone L, Enrini R, Caviezel F. Obesity and Coronary Artery Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 1999:13(3); 280-284.
      • Schwann TA, Habib RH, Zacharias A, Parenteau GL, Riordan CJ, Durham SJ, Engoren M. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001;71:521-31.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill cardiovascular surgical patients, what effect does weight have on infectious complications?

  • Conclusion
    There is fair evidence that BMI < 21 and BMI > 28 are associated with increased rate of infection in critically ill cardiovascular surgery patients.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill cardiovascular surgical patients, what effect does weight have on infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ, Couper GS, Allred EN, Cohn LH, Rizzo RJ. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 1999;118:866-873.
        
      • Potapov EV, Matthias L, Anker S, Stein J, Bondy S, Naserri BA, Sodian R, Hausmann H and Hetzer R. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. European Heart J. 2003; 24:1933-1941.
      • Ranucci M, Cazzaniga A, Soro G, Morricone L, Enrini R, Caviezel F. Obesity and Coronary Artery Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 1999:13(3); 280-284.
      • Schwann TA, Habib RH, Zacharias A, Parenteau GL, Riordan CJ, Durham SJ, Engoren M. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001;71:521-31.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill cardiovascular surgical patients, what effect does weight have on length of hospital stay?

  • Conclusion
    There is fair evidence that both BMI < 24 and BMI > 34 are associated with increased LOS in critically ill cardiovascular surgery patients.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill cardiovascular surgical patients, what effect does weight have on length of hospital stay?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ, Couper GS, Allred EN, Cohn LH, Rizzo RJ. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 1999;118:866-873.
        
      • Potapov EV, Matthias L, Anker S, Stein J, Bondy S, Naserri BA, Sodian R, Hausmann H and Hetzer R. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. European Heart J. 2003; 24:1933-1941.
      • Ranucci M, Cazzaniga A, Soro G, Morricone L, Enrini R, Caviezel F. Obesity and Coronary Artery Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 1999:13(3); 280-284.
      • Schwann TA, Habib RH, Zacharias A, Parenteau GL, Riordan CJ, Durham SJ, Engoren M. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001;71:521-31.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill cardiovascular surgical patients, what effect does weight have on days on mechanical ventilation?

  • Conclusion
    There is limited evidence that both BMI <23 and BMI >34 are associated with increased days on mechanical ventilation in critically ill cardiovascular surgery patients.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill cardiovascular surgical patients, what effect does weight have on days on mechanical ventilation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ, Couper GS, Allred EN, Cohn LH, Rizzo RJ. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 1999;118:866-873.
        
      • Potapov EV, Matthias L, Anker S, Stein J, Bondy S, Naserri BA, Sodian R, Hausmann H and Hetzer R. Impact of body mass index on outcome in patients after coronary artery bypass grafting with and without valve surgery. European Heart J. 2003; 24:1933-1941.
      • Ranucci M, Cazzaniga A, Soro G, Morricone L, Enrini R, Caviezel F. Obesity and Coronary Artery Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 1999:13(3); 280-284.
      • Schwann TA, Habib RH, Zacharias A, Parenteau GL, Riordan CJ, Durham SJ, Engoren M. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001;71:521-31.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill cardiovascular surgical patients, what effect does weight have on cost of medical care?

  • Conclusion
    There is limited evidence that BMI < 24 and BMI > 34 are associated with increased cost of medical care in critically ill cardiovascular surgery patients.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill cardiovascular surgical patients, what effect does weight have on cost of medical care?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Schwann TA, Habib RH, Zacharias A, Parenteau GL, Riordan CJ, Durham SJ, Engoren M. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001;71:521-31.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006