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American Journal of Clinical Nutrition, Vol. 87, No. 6, 1656-1661, June 2008
© 2008 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery1,2,3

Lenny MW van Venrooij, Rien de Vos, Mieke MMJ Borgmeijer-Hoelen, Cees Haaring and Bas AJM de Mol

1 From the Divisions of Dietetics (LMWV), Clinical Epidemiology and Biostatistics (RV), and Cardiac Thoracic Surgery (LMVV, MMMJB-H, and BAJMM), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands, and the Trial Office, Division of Radiology, University Medical Center, Utrecht, the Netherlands (CH)

Background: Several studies reported increased adverse outcomes after cardiac surgery in patients with low body mass index (BMI; in kg/m2). Little is known yet, however, about the effect of preoperative unintended weight loss (UWL) in cardiac surgery patients.

Objective: We explored the prevalence and effect of UWL in view of low BMI and vice versa adjusted for a validated set of preoperative risks, inflammatory activity, and duration of extracorporeal circulation on postoperative adverse outcome.

Design: A prospective cohort study was performed. Nutritional data of cardiac surgery patients were collected within 24 h of admission and linked to the standard postoperative complication registration database.

Results: The cohort consisted of 331 cases. Multivariate logistic regression analyses showed that preoperative UWL of ≥10% in the past 6 mo (≥10%UWLin6m) was associated with a prolonged length of stay in the hospital independent from low BMI [odds ratio (OR): 7.06; 95% CI: 1.78, 28.04]. Preoperative BMI ≤ 21.0 was associated with an increased incidence of postoperative infections and prolonged stay in the intensive care unit independent from ≥10%UWLin6m (OR: 4.62; 95% CI: 1.20, 17.82; and OR: 5.27; 95% CI: 1.28, 21.76, respectively). Preoperative undernutrition in cardiac surgery patients (≥10%UWLin6m or BMI ≤ 21.0 or both) was present in 9.1% of the study population (4.3% and 4.8%, respectively).

Conclusions: From this study, we recommend special attention for cardiac surgery patients with preoperative ≥10%UWLin6m or BMI ≤ 21.0 because both variables are independently related to adverse outcomes. Preoperative referral to a dietitian for further diagnostic assessment and nutritional treatment is strongly recommended.






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