Patients who are overweight or obese are less likely to die in hospital after a heart operation than those who are a healthy weight, a study has found.
The results of the British Heart Foundation (BHF)-funded research suggest it is wrong to deny people surgery because they are overweight and that underweight patients could benefit from gaining weight prior to a heart operation.
A team at the University of Leicester collected data on about 400,000 adults in the UK and Ireland who underwent cardiac surgery between 2002 and 2013, categorising them into different weight categories, according to their BMI (body mass index).
Of those included, 11,511 patients died in hospital, including 4.4% of patients who were of healthy weight, compared with only 2.8% of those who were overweight and 2.7% in obese class I (with a BMI of 30 to 35). The study, published on Friday in the journal Circulation, found that 8.5% of patients who were underweight died in hospital.
Gavin Murphy, BHF professor of cardiac surgery at the University of Leicester, said: “We saw a 25% reduction in death by being overweight as opposed to being normal [healthy] weight. That’s a bigger effect on mortality than statins.
“It changes one of the most basic approaches behind surgery, which is that people need to lose weight before surgery. Obese patients are generally considered unfit for surgery. This study shows the very morbidly obese – with a BMI greater than 40 – did not have a greater risk. It shows that no patient should be rejected for surgery on the basis of body mass.”
The authors believe the study confirms the existence of the much-debated obesity paradox, whereby obesity can cause illnesses, such as heart disease or a heart attack but at the same time have certain protective effects.
Murphy said they found a linear association between increasing BMI and lower risk of acute heart failure or acute stroke but the relationship did not hold for all adverse outcomes post-surgery (infections, for example). How being overweight or obese protects patients who undergo surgery is unknown but the researchers plan to investigate this in future.
“If you imagine that having a heart operation is like climbing a mountain, you’re probably better doing that if you’re nutritionally nourished than if you’re under-nourished, if you’re having an energy surplus than having an energy deficit, although it’s probably a bit more complex than that,” said Murphy.
The researchers found that overweight or obese patients had greater protection regardless of age and even if they had experienced complications associated with obesity, such as hypertension, diabetes and coronary artery disease.
They also reviewed data from 557,720 further patients included in studies across Europe, the United States and Asia, finding similar results.
BHF’s associate medical director, Prof Jeremy Pearson, said: “We always recommend a healthy waistline, which significantly reduces lifetime risk of heart disease and therefore a person’s risk of needing cardiac surgery. However, this large study strongly suggests that being overweight can give patients added protection when facing major heart surgery, reducing their chance of complications or death before leaving hospital.”
A large number of NHS groups are believed to have placed restrictions on access to surgery for overweight people, although, in most cases this applies to elective procedures for non-life-threatening conditions such as hip and knee replacements.
Overweight patients less likely to die in hospital after heart operations
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