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Weight impacts 1-year congenital heart surgery outcomes independent of race/ethnicity and payer

Published online by Cambridge University Press:  19 November 2020

Saira Siddiqui Open the ORCID record for Saira Siddiqui [Opens in a new window] ,
Brett R. Anderson ,
Damien J. LaPar ,
David Kalfa ,
Paul Chai ,
Emile Bacha  and
Lindsay Freud
Saira Siddiqui*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
Brett R. Anderson
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
Damien J. LaPar
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
David Kalfa
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
Paul Chai
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
Emile Bacha
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
Lindsay Freud
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
*
Author for correspondence: Dr S. Siddiqui, MD, Columbia University Irving Medical Center, Division of Pediatric Cardiology, 3959 Broadway, CH-2 N, NY 10032, USA. Tel: +1 973-971-5000; Fax: 212-342-5721. E-mail: [email protected]
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Abstract

Body mass index, race/ethnicity, and payer status are associated with operative mortality in congenital heart disease (CHD). Interactions between these predictors and impacts on longer term outcomes are less well understood. We studied the effect of body mass index, race/ethnicity, and payer on 1-year outcomes following elective CHD surgery and tested the degree to which race/ethnicity and payer explained the effects of body mass index. Patients aged 2–25 years who underwent elective CHD surgery at our centre from 2010 to 2017 were included. We assessed 1-year unplanned cardiac re-admissions, re-interventions, and mortality. Step-wise, multivariable logistic regression was performed.

Of the 929 patients, 10.4% were underweight, 14.9% overweight, and 8.5% obese. Non-white race/ethnicity comprised 40.4% and public insurance 29.8%. Only 0.5% died prior to hospital discharge with one additional death in the first post-operative year. Amongst patients with continuous follow-up, unplanned re-admission and re-intervention rates were 14.7% and 12.3%, respectively. In multivariable analyses adjusting for surgical complexity and surgeon, obese, overweight, and underweight patients had higher odds of re-admission than normal-weight patients (OR 1.40, p = 0.026; OR 1.77, p < 0.001; OR 1.44, p = 0.008). Underweight patients had more than twice the odds of re-intervention compared with normal weight (OR 2.12, p < 0.001). These associations persisted after adjusting for race/ethnicity, payer, and surgeon.

Pre-operative obese, overweight, and underweight body mass index were associated with unplanned re-admission and/or re-intervention 1-year following elective CHD surgery, even after accounting for race/ethnicity and payer status. Body mass index may be an important modifiable risk factor prior to CHD surgery.

Keywords

Congenital heart diseasecardiac surgical outcomesbody mass indexracepayer
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 279 - 285
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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