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Research Article|Articles in Press

Predictors of Outcomes in Patients with Obesity Following Mitral Valve Surgery

Open AccessPublished:May 09, 2023DOI:https://doi.org/10.1016/j.xjon.2023.03.017
Predictors of Outcomes in Patients with Obesity Following Mitral Valve Surgery
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      ABSTRACT

      Objective

      Few studies have assessed the outcomes of mitral valve surgery in patients with obesity. We sought to study factors that determine the in-hospital outcomes of this population to help clinicians provide optimal care.

      Methods

      A retrospective analysis of adult patients with obesity who underwent open mitral valve replacement or repair (MVR) between January 1, 2012, and December 31, 2020, was conducted using the National Inpatient Sample. Weighted logistic regression and random forest analyses were performed to assess factors associated with mortality and the interaction of each variable.

      Results

      Of the 48,775 patients with obesity, 34% had morbid obesity (BMI≥40), 55% were female, 66% underwent elective surgery, and 55% received isolated MVR. In-hospital mortality was 5.0% (n=2,430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (aOR:1.24, CI:1.08-1.43), higher Elixhauser comorbidity score (aOR:2.10, CI:1.87-2.36), prior valve surgery (aOR:1.63, CI:1.01-2.63), and more than 2 concomitant procedures (aOR:2.83, CI:2.07-3.85). Lower mortality was associated with elective admissions (aOR:0.70, CI:0.56-0.87) and valve repair (aOR:0.58, CI:0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, BMI≥40, and kidney failure.

      Conclusion

      The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in MVR patients. Morbid obesity and sex disparity should be recognized in this population, and physicians should consider older patients and females with multiple comorbidities for earlier and more opportune treatment windows.

      Keywords

      ABBREVIATIONS:

      MVR (Mitral Valve Surgery), BMI (Body Mass Index), OR (Odds Ratio), aOR (Adjusted odd ratios), CI (Confident interval), CABG (Coronary artery bypass grafting), HCUP (Health Care Cost and Utilization Project), NIS (Nationwide Inpatient Sample), AHRQ (Agency for Healthcare Research and Quality), ICD (International Classification of Disease used to classify diseases, injuries, and procedures), LOS (Length of stay), bRF (Balanced random forest), AVR (Aortic valve replacement), AUC (Area Under Curve), FPL (Federal poverty level), CHF (Congestive heart failure), CKD (Chronic kidney disease), MI (Myocardial infarction), DM (Diabetes mellitus), PAD (Peripheral arterial disease), CAD (Coronary artery disease), SES (Socioeconomic status), COPD (Chronic obstructive pulmonary disease), VIMP (Variable Importance)

      Article info

      Publication history

      Accepted: March 14, 2023
      Received: September 18, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      This work was presented at the AATS Mitral Conclave Workshop, Boston, MA, May 13-14, 2022.

      Disclosures: The authors declare no conflict of interest related to this work.

      Funding Statement: No funding was received for this work.

      IRB Statement: The study did not involve living human subjects or accessing identifiable information or identifiable biospecimens. For this reason, our human Subject Research Office (HSRO), determined that this study does not require institutional review board (IRB) review, approval, or oversight.

      Informed Consent Statement: N/A

      Central Message

      Mortality risk after mitral surgery in patients with obesity can be improved by better clinical management of other comorbidities.

      Perspective Statement

      Patients with obesity are at increased risk of morbidity and mortality, especially older and female patients with multiple comorbidities. Thus, addressing the modifiable factors associated with mortality in these patients could offer clinicians the chance to tailor their pre- and postoperative care for more optimal outcomes following mitral valve surgery.

      Central Picture legend: National trends of mitral valve surgery and obesity (2012-2020).

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.03.017

      Copyright

      © 2023 The Author(s). Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.

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