BMI Is an Independent Preoperative Predictor of Intraoperative Transfusion and Postoperative Chest-Tube Output

Abstract

Background An increasing obese population in the United States focuses attention on perioperative management of obese and overweight patients.

Objective We sought to determine if obesity, determined by body mass index (BMI), was a preoperative indicator of bleeding in coronary artery bypass graft (CABG) surgery as measured by intraoperative packed red blood cell transfusion frequency and 24-hour chest-tube output amount.

Methods A retrospective chart review examined 290 consecutive patients undergoing single-surgeon off-pump or on-pump CABG surgery between November 2003 and April 2009. Preoperative variables of age, gender, hematocrit, platelet count, and BMI, chest tube output during the immediate 24-hour postoperative period, and the type of procedure (on-pump vs. off-pump) were analyzed. Logistic regression analysis was used to evaluate the likelihood of intraoperative transfusion. Linear regression analysis was used to evaluate 24-hour chest-tube output.

Results Preoperative variables that significantly increased the likelihood of intraoperative transfusions were older age and low hematocrit; a significant decrease in likelihood was found with male gender, overweight BMI, and off-pump procedures. Preoperative variables that significantly increased 24-hour chest-tube output were low hematocrit, high hematocrit, and low platelets while a significant decrease in output was seen with overweight BMI and obese BMI.

Conclusion Overweight and obese BMI are significant independent predictors of decreased intraoperative transfusion and decreased postoperative blood loss.

Keywords

obesity - BMI - CABG - intraoperative transfusion - chest-tube output

• References

• 1 World Health Organization [Internet]. Obesity and overweight. Fact sheet no. 311. May 2012. http://www.who.int/mediacentre/factsheets/fs311/en/index.html . Accessed July 15, 2012
• 2 American Heart Association [Internet]. Obesity information. Updated May 5, 2011. http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/Obesity/Obesity-Information_UCM_307908_Article.jsp#.T1pFH3qi2So . Accessed July 15, 2012
• 3 Centers for Disease Control and Prevention [Internet]. Adult obesity facts. http://www.cdc.gov/obesity/data/adult.html . Accessed July 15, 2012
• 4 Engel AM, McDonough S, Smith JM. Does an obese body mass index affect hospital outcomes after coronary artery bypass graft surgery?. Ann Thorac Surg 2009; 88 (6) 1793-1800
• 5 Yap CH, Zimmet A, Mohajeri M, Yii M. Effect of obesity on early morbidity and mortality following cardiac surgery. Heart Lung Circ 2007; 16 (1) 31-36
• 6 Kuduvalli M, Grayson AD, Oo AY, Fabri BM, Rashid A. Risk of morbidity and in-hospital mortality in obese patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 2002; 22 (5) 787-793
• 7 Nunez TC, Voskresensky IV, Dossett LA, Shinall R, Dutton WD, Cotton BA. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)?. J Trauma 2009; 66 (2) 346-352
• 8 Cobain TJ, Vamvakas EC, Wells A, Titlestad K. A survey of the demographics of blood use. Transfus Med 2007; 17 (1) 1-15
• 9 Sucker C, Litmathe J, Feindt P, Zotz R. Platelet function analyzer (PFA-100) as a useful tool for the prediction of transfusion requirements during aortic valve replacement. Thorac Cardiovasc Surg 2011; 59 (4) 233-236
• 10 Welsby I, Crow J, Bandarenko N, Lappas G, Phillips-Bute B, Stafford-Smith M. A clinical prediction tool to estimate the number of units of red blood cells needed in primary elective coronary artery bypass surgery. Transfusion 2010; 50 (11) 2337-2343
• 11 Karkouti K, McCluskey SA, Syed S, Pazaratz C, Poonawala H, Crowther MA. The influence of perioperative coagulation status on postoperative blood loss in complex cardiac surgery: a prospective observational study. Anesth Analg 2010; 110 (6) 1533-1540
• 12 Wasowicz M, McCluskey SA, Wijeysundera DN , et al. The incremental value of thrombelastography for prediction of excessive blood loss after cardiac surgery: an observational study. Anesth Analg 2010; 111 (2) 331-338
• 13 Nolan HR, Ramaiah C. Effect of body mass index on postoperative transfusions and 24-hour chest-tube output. Int J Angiol 2011; 20 (2) 81-86
• 14 American Heart Association [Internet]. Obesity and overweight. AHA Scientific Position. Updated March 29, 2012. http://www.heart.org/HEARTORG/GettingHealthy/Obesity-and-Overweight_UCM_306016_Article.jsp#.T1pFKHqi2So . Accessed July 15, 2012
• 15 Covin R, O'Brien M, Grunwald G , et al. Factors affecting transfusion of fresh frozen plasma, platelets, and red blood cells during elective coronary artery bypass graft surgery. Arch Pathol Lab Med 2003; 127 (4) 415-423
• 16 Elmistekawy EM, Errett L, Fawzy HF. Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting—the experience of a single cardiac center: a prospective observational study. J Cardiothorac Surg 2009; 4: 20
• 17 Schwann TA, Habib RH, Zacharias A , et al. Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Ann Thorac Surg 2001; 71 (2) 521-530 , discussion 530–531
• 18 Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. J Am Coll Cardiol 2003; 42 (4) 668-676
• 19 Arora RC, Légaré JF, Buth KJ, Sullivan JA, Hirsch GM. Identifying patients at risk of intraoperative and postoperative transfusion in isolated CABG: toward selective conservation strategies. Ann Thorac Surg 2004; 78 (5) 1547-1554
• 20 Scott BH, Seifert FC, Glass PS, Grimson R. Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Anesth Analg 2003; 97 (4) 958-963
• 21 van Straten AH, Kats S, Bekker MW , et al. Risk factors for red blood cell transfusion after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2010; 24 (3) 413-417
• 22 Sensoz Y, Gunay R, Tuygun AK , et al. Computed tomography evaluation of different chest tube sites for residual pleural volumes after coronary artery bypass surgery. Ann Saudi Med 2011; 31 (4) 383-386
• 23 Alam M, Siddiqui S, Lee VV , et al. Isolated coronary artery bypass grafting in obese individuals: a propensity matched analysis of outcomes. Circ J 2011; 75 (6) 1378-1385
• 24 Birkmeyer NJ, Charlesworth DC, Hernandez F , et al; Northern New England Cardiovascular Disease Study Group. Obesity and risk of adverse outcomes associated with coronary artery bypass surgery. Circulation 1998; 97 (17) 1689-1694
• 25 Kim J, Hammar N, Jakobsson K, Luepker RV, McGovern PG, Ivert T. Obesity and the risk of early and late mortality after coronary artery bypass graft surgery. Am Heart J 2003; 146 (3) 555-560
• 26 Wynne R, Botti M, Copley D, Bailey M. The normative distribution of chest tube drainage volume after coronary artery bypass grafting. Heart Lung 2007; 36 (1) 35-42
• 27 Alghamdi AA, Moussa F, Fremes SE. Does the use of preoperative aspirin increase the risk of bleeding in patients undergoing coronary artery bypass grafting surgery? Systematic review and meta-analysis. J Card Surg 2007; 22 (3) 247-256
• 28 Shapira OM, Aldea GS, Zelingher J , et al. Enhanced blood conservation and improved clinical outcome after valve surgery using heparin-bonded cardiopulmonary bypass circuits. J Card Surg 1996; 11 (5) 307-317
• 29 Shehata N, Naglie G, Alghamdi AA , et al. Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery: a systematic review. Vox Sang 2007; 93 (1) 1-11