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Johnson A, Hore E, Milne B, Muscedere J, Peng Y, McIsaac DI, Parlow J. A Frailty Index to Predict Mortality, Resource Utilization and Costs in Patients Undergoing Coronary Artery Bypass Graft Surgery in Ontario. CJC Open 2024; 6:72-81. [PMID: 38585676 PMCID: PMC10994976 DOI: 10.1016/j.cjco.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/11/2023] [Indexed: 04/09/2024] Open
Abstract
Background People living with frailty are vulnerable to poor outcomes and incur higher health care costs after coronary artery bypass graft (CABG) surgery. Frailty-defining instruments for population-level research in the CABG setting have not been established. The objectives of the study were to develop a preoperative frailty index for CABG (pFI-C) surgery using Ontario administrative data; assess pFI-C suitability in predicting clinical and economic outcomes; and compare pFI-C predictive capabilities with other indices. Methods A retrospective cohort study was conducted using health administrative data of 50,682 CABG patients. The pFI-C comprised 27 frailty-related health deficits. Associations between index scores and mortality, resource use and health care costs (2022 Canadian dollars [CAD]) were assessed using multivariable regression models. Capabilities of the pFI-C in predicting mortality were evaluated using concordance statistics; goodness of fit of the models was assessed using Akakie Information Criterion. Results As assessed by the pFI-C, 22% of the cohort lived with frailty. The pFI-C score was strongly associated with mortality per 10% increase (odds ratio [OR], 3.04; 95% confidence interval [CI], [2.83,3.27]), and was significantly associated with resource utilization and costs. The predictive performances of the pFI-C, Charlson, and Elixhauser indices and Johns Hopkins Aggregated Diagnostic Groups were similar, and mortality models containing the pFI-C had a concordance (C)-statistic of 0.784. Cost models containing the pFI-C showed the best fit. Conclusions The pFI-C is predictive of mortality and associated with resource utilization and costs during the year following CABG. This index could aid in identifying a subgroup of high-risk CABG patients who could benefit from targeted perioperative health care interventions.
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Affiliation(s)
- Ana Johnson
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Elizabeth Hore
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Brian Milne
- Department of Anesthesiology and Perioperative Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Yingwei Peng
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Daniel I. McIsaac
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Prasitlumkum N, Chokesuwattanaskul R, Kaewput W, Thongprayoon C, Bathini T, Boonpheng B, Vallabhajosyula S, Cheungpasitporn W, Jongnarangsin K. Utilization and in-hospital complications of catheter ablation for atrial fibrillation in patients with obesity and morbid obesity. Clin Cardiol 2022; 45:407-416. [PMID: 35170775 PMCID: PMC9019886 DOI: 10.1002/clc.23795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background Real‐world data on atrial fibrillation (AF) ablation outcomes in obese populations have remained scarce, especially the relationship between obesity and in‐hospital AF ablation outcome. Hypothesis Obesity is associated with higher complication rates and higher admission trend for AF ablation. Methods We drew data from the US National Inpatient Sample to identify patients who underwent AF ablation between 2005 and 2018. Sociodemographic and patients' characteristics data were collected, and the trend, incidence of catheter ablation complications and mortality were analyzed, and further stratified by obesity classification. Results A total of 153 429 patients who were hospitalized for AF ablation were estimated. Among these, 11 876 obese patients (95% confidence interval [CI]: 11 422–12 330) and 10 635 morbid obese patients (95% CI: 10 200–11 069) were observed. There was a substantial uptrend admission, up to fivefold, for AF ablation in all obese patients from 2005 to 2018 (p < .001). Morbidly obese patients were statistically younger, while coexisting comorbidities were substantially higher than both obese and nonobese patients (p < .01) Both obesity and morbid obesity were significantly associated with an increased risk of total bleeding, and vascular complications (p < .05). Only morbid obesity was significantly associated with an increased risk of ablation‐related complications, total infection, and pulmonary complications (p < .01). No difference in‐hospital mortality was observed among obese, morbidly obese, and nonobese patients. Conclusion Our study observed an uptrend in the admission of obese patients undergoing AF ablation from 2005 through 2018. Obesity was associated with higher ablation‐related complications, particularly those who were morbidly obese.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Medicine, University of California Riverside, Riverside, California, USA
| | - Ronpichai Chokesuwattanaskul
- Department of Medicine, Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University, Bangkok, Thailand
| | - Wisit Kaewput
- Department of Medicine, Department of Military and Community Medicine, Division of Nephrology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Tarun Bathini
- Department of Cardiology, Bassett Medical Center, Cooperstown, New York, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Saraschandra Vallabhajosyula
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA
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Liu X, Chu H, Ji Y, Bosnjak Z, Ao H, Li T. Which BMI for Diabetes Patients is Better? From the View of the Adipose Tissue Macrophage-Derived Exosome. Diabetes Metab Syndr Obes 2022; 15:141-153. [PMID: 35046685 PMCID: PMC8763208 DOI: 10.2147/dmso.s345890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/24/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Diabetes, as a group of metabolic diseases, can elevate blood glucose, thus leading to the development of life-threatening complications. It is difficult to define the outcome for diabetics with different BMI. This review will illustrate the adipose tissue macrophage-derived exosome in the diabetics with different BMI. PATIENTS AND METHODS Insulin resistance in peripheral tissues can cause diabetes. The peripheral tissues include liver, muscle, or the adipose depots. Communication between these organs is fatal to the maintenance of glucose homeostasis. This review will illustrate this communication. Obesity is closely linked with diabetes. There are different changes in fat distribution in diabetic patients. Adipose tissue macrophages can secrete various hormones, including adiponectin, leptin, resistin and other classical cytokines, such as TNF-α and IL-6. Studies illustrated that exosomes from the adipose tissue, can modulate inter-organ cross-talk by regulating gene expression in other tissues. RESULTS Adipose tissue macrophages exosomes links thin and fat individuals in the development of diabetes. CONCLUSION The molecular pathways initiated by exosomes such as miRNA in the situations of metabolic stress could help us gain a deeper knowledge of the pathophysiology of diabetes.
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Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
- Departments of Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Haichen Chu
- Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
| | - Yuzhi Ji
- Obstetrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
| | - Zeljko Bosnjak
- Departments of Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hushan Ao
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Hushan Ao Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, People’s Republic of ChinaTel/Fax +86-10-68006210 Email
| | - Tianjun Li
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
- Tianjun Li Department of Oncology, Affiliated Hospital of Qingdao University, No. 59 Haier Road, Laoshan District, Qingdao, Shandong Province, People’s Republic of ChinaTel/Fax +86-10-82913035 Email
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Lamelas J, Alnajar A. Size does matter: Yet BMI extremes are manageable in minimally invasive cardiac surgery. J Card Surg 2021; 37:124-125. [PMID: 34734667 DOI: 10.1111/jocs.16095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
The obesity paradox has been recently challenged in the literature to spotlight a vague and ill-defined relationship between obesity extremes and cardiac morbidity and mortality. Patient size and incision size both remain important determinants of outcomes. Today, with obesity rates rising around the world, extremely obese patients require experienced teams and substantially improved care.
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Affiliation(s)
- Joseph Lamelas
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Alnajar
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Gupta N, Sheng Z. Beyond weight: examining the association of obesity with cardiometabolic related inpatient costs among Canadian adults using linked population based survey and hospital administrative data. BMC Health Serv Res 2021; 21:54. [PMID: 33430872 PMCID: PMC7802132 DOI: 10.1186/s12913-020-06051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/28/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The global population has transitioned to one where more adults are living with obesity than are underweight. Obesity is associated with the development of cardiometabolic diseases and widely attributed to increased hospital resource use; however, empirical evidence is limited regarding obesity prevention to support hospital cost containment. This study aims to test for obesity in predicting hospitalization costs for cardiometabolic conditions among the Canadian population aged 45 and over. METHODS Data from the 2007-2011 Canadian Community Health Survey were linked to eight years of hospital discharge records. A cohort was identified of inpatients admitted for diabetes, hypertension, and other cardiometabolic diseases. Multiple linear regressions were used to investigate the association between obesity status and inpatient costs, controlling for sociodemographic and behavioural factors. RESULTS The target cohort included 23,295 admissions for cardiometabolic diseases. Although inflation-adjusted inpatient costs generally increased over time, compared with the non-obese group, living with obesity was not a significant predictor of differences in cardiometabolic-related resource use (0.972 [95% CI: 0.926-1.021]). Being female and rural residence were found to be protective factors. CONCLUSIONS Obesity was not found in this study to be independently linked to higher cardiometabolic hospitalization costs, suggesting that actions to mitigate disease progression in the population may be more beneficial than simply promoting weight loss. Results amplified the need to consider gender and urbanization when formulating which levers are most amenable to adoption of healthy lifestyles to reduce impacts of obesogenic environments to the healthcare system.
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Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, P.O. Box 4400, E3B 5A3, Fredericton, New Brunswick, Canada.
| | - Zihao Sheng
- Department of Economics, Dalhousie University, Halifax, Canada
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Liu X, Zhang W, Wang L, Wang S, Yu Y, Chen S, Ao H. Male patients with diabetes undergoing coronary artery bypass grafting have increased major adverse cerebral and cardiovascular events. Interact Cardiovasc Thorac Surg 2019; 28:607-612. [PMID: 30325425 DOI: 10.1093/icvts/ivy287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The role of body mass index (BMI) in the prognosis of patients with diabetes undergoing coronary artery bypass grafting (CABG) has been of great interest for a long time. However, the precise relationship between BMI and major adverse cerebral and cardiovascular events (MACCEs) in these patients is still unclear. The goal of this study was to investigate the outcome of patients with diabetes with different BMIs undergoing CABG and the results from the 5-year follow-up. METHODS This study included 771 patients with diabetes undergoing CABG from 1 January 2003 to 31 December 2009. They were classified based on the Chinese standard for BMI as follows: underweight: <18.5 kg/m2; normal weight: 18.5-23.9 kg/m2; overweight: 24-27.9 kg/m2; and obese: >28 kg/m2. Short-term outcomes and 5-year MACCEs were compared among various BMI groups after surgery. RESULTS Obese and overweight patients with diabetes tended to be younger than normal weight patients [57 years (49-64) vs 62 years (54-68) and 64 years (59-69); P < 0.001]. There were fewer male patients (25.20% vs 17.78% and 16.54%, P = 0.041). More smokers were in the 2 groups (38.8% vs 51.55% and 57.14%, P < 0.001). Glucose concentration was highest in the overweight group [6.40 (5.40-7.80) vs 6.96 (5.69-8.22) and 6.80 (5.90-8.40); P = 0.041)]. Cox regression analysis of the 5-year follow-up data indicated that various BMI groups were not associated with significant differences in 5-year MACCEs; however, male sex was the risk factor for MACCEs (hazard ratio 1.83, 95% confidence interval 1.11-3.04; P = 0.019). CONCLUSIONS The BMI of the patients with diabetes undergoing CABG had no effect on MACCEs. Male sex was the risk factor in these patients.
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Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenyuan Zhang
- Department of Anesthesiology, The First affiliated Hospital, Nanchang University, Nanchang, China
| | - Lijuan Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Yu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sipeng Chen
- The Department of Information Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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De Santo LS, Moscariello C, Zebele C. Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis. J Thorac Dis 2018; 10:4532-4539. [PMID: 30174906 DOI: 10.21037/jtd.2018.06.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A U-shaped relationship between body mass index (BMI) and outcomes emerged after cardiac surgery. This review analyses the physio pathologic basis of obesity related complications and evaluates prognostic implications. Both leaner and morbid obese should be considered pre-operatively rather than reactively and, when referred for elective surgery, should undergo a focused metabolic status management, and a thorough evaluation of health status. Adherence to sound surgical principles, and tailored patient blood management and perioperative care are mandatory.
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Affiliation(s)
- Luca Salvatore De Santo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| | - Caesar Moscariello
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| | - Carlo Zebele
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
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