The Impact of Obesity on Early Postoperative Outcomes in Adults
with Congenital Heart Disease
Ali N. Zaidi, MD,*
,†
John A. Bauer, PhD,
‡
Marc P. Michalsky, MD,
§
Vincent Olshove, CCP, CCT,
¶
Bethany Boettner, MA,
‡
Alistair Phillips, MD,
¶
and Stephen C. Cook, MD, FACC*
,†
*The Adolescent and Adult Congenital Heart Disease Program, The Heart Center, Nationwide Children’s Hospital,
Columbus, Ohio, USA;
†
The Ross Heart Hospital, Ohio State University, Columbus, Ohio, USA;
‡
The Research Institute,
Nationwide Children’s Hospital, Columbus, Ohio, USA;
§
Surgical Director, Healthy Center for Weight and Nutrition,
Nationwide Children’s Hospital, Columbus, Ohio, USA;
¶
Department of Cardiothoracic Surgery, Nationwide Children’s
Hospital, Columbus, Ohio, USA
ABSTRACT
Background. As the prevalence of obesity continues to increase, it now includes the growing number of patients
with congenital heart disease (CHD). This particular obese patient population may pose additional intraoperative as
well as postoperative challenges that may contribute to poor outcomes. Our aims were to determine the influence
of obesity on morbidity and mortality in adults with CHD undergoing surgical repair at a free standing children’s
hospital.
Methods. A retrospective analysis of adult (18 years) CHD surgery cases from 2002 to 2008 was performed.
Congenital heart lesions were defined as mild, moderate, or complex. Patients were categorized by body mass index
(BMI): underweight (BMI < 20 kg/m
2
), normal (BMI 20–24.9 kg/m
2
), overweight (BMI 25–29.9 kg/m
2
), and obese
(BMI 30 kg/m
2
). Demographics, incidence of mortality, or specific morbidities were statistically compared using
Fisher’s exact test and analyses of variance (anovas).
Results. In this population (n = 165), overweight (29%) and obese (22%) patients were prevalent. Hypertension
(HTN) and pre-HTN were more prevalent in obese and overweight patients. Postoperative renal dysfunction was
observed in obese patients with complex CHD (P = .04). Mortality was not different among groups.
Conclusions. Obesity is becoming increasingly common among adults with CHD. Despite marginal evidence of
postoperative renal complications in obese patients with CHD of severe complexity, the overall presence of obesity
did not influence mortality or short term postoperative morbidities.
Key Words. Adults with CHD; Obesity; Postoperative Morbidity; Mortality
Introduction
T
he prevalence of obesity; defined as a body
mass index (BMI) > 30 kg/m
2
, is increasing
at an alarming rate, now affecting an increasing
number of children, adolescents, and young adults
throughout the United States. Obesity increases
the risk of several comorbid conditions, including
early development of atherosclerosis, diabetes
mellitus, hypertension, hyperlipidemia, nonalco-
holic fatty liver disease, and stroke in both adoles-
cents and adults.
1–4
Despite increasing public
awareness that obesity is a major risk factor for
cardiovascular disease and death, the proportion
of adults and children who are obese are reaching
epidemic proportions.
1
Based on data from the 2003–2004 US National
Health and Nutrition Examination Survey,
approximately 66 million American adults are
obese and an additional 74 million are overweight.
Among American children aged 6–11 years,
approximately 4.2 million (prevalence of 18.8%)
are overweight, while among American adoles-
cents aged 12–19 years, 5.7 million (prevalence of
17.4%) are overweight. Assuming that the same
trends continue, by 2015, two in every five adults
and one in every four children in the United States
will be obese.
5,6
241
© 2011 Copyright the Authors
Congenital Heart Disease © 2011 Wiley Periodicals, Inc. Congenit Heart Dis. 2011;6:241–246