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Impact of obesity on post-operative arrhythmias after congenital heart surgery in children and young adults

Part of: Surgery

Published online by Cambridge University Press:  06 January 2022

Andrew E. Radbill*
Affiliation:
Department of Pediatrics, Division of Cardiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
Andrew H. Smith
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA Department of Pediatrics, Division of Critical Care Medicine, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA
Sara L. Van Driest
Affiliation:
Department of Pediatrics, Division of General Pediatrics, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
Frank A. Fish
Affiliation:
Department of Pediatrics, Division of Cardiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
David P. Bichell
Affiliation:
Department of Cardiac Surgery, Division of Pediatric Cardiac Surgery, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
Bret A. Mettler
Affiliation:
Department of Cardiac Surgery, Division of Pediatric Cardiac Surgery, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA Department of Cardiac Surgery, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
Karla G. Christian
Affiliation:
Department of Cardiac Surgery, Division of Pediatric Cardiac Surgery, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
Todd L. Edwards
Affiliation:
Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
Prince J. Kannankeril
Affiliation:
Department of Pediatrics, Division of Cardiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
*
Author for correspondence: A. E. Radbill, MD, Department of Pediatrics, Division of Cardiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, 2200 Childrens Way, Doctor’s Office Tower Suite 5230, Nashville, TN37232, USA. Tel: 615-322-7447; Fax: 615-322-2210. E-mail: andrew.radbill@vumc.org

Abstract

Background:

Obesity increases the risk of post-operative arrhythmias in adults undergoing cardiac surgery, but little is known regarding the impact of obesity on post-operative arrhythmias after CHD surgery.

Methods:

Patients undergoing CHD surgery from 2007 to 2019 were prospectively enrolled in the parent study. Telemetry was assessed daily, with documentation of all arrhythmias. Patients aged 2–20 years were categorised by body mass index percentile for age and sex (underweight <5, normal 5–85, overweight 85–95, and obese >95). Patients aged >20 years were categorised using absolute body mass index. We investigated the impact of body mass index category on arrhythmias using univariate and multivariate analysis.

Results:

There were 1250 operative cases: 12% underweight, 65% normal weight, 12% overweight, and 11% obese. Post-operative arrhythmias were observed in 38%. Body mass index was significantly higher in those with arrhythmias (18.8 versus 17.8, p = 0.003). There was a linear relationship between body mass index category and incidence of arrhythmias: underweight 33%, normal 38%, overweight 42%, and obese 45% (p = 0.017 for trend). In multivariate analysis, body mass index category was independently associated with post-operative arrhythmias (p = 0.021), with odds ratio 1.64 in obese patients as compared to normal-weight patients (p = 0.036). In addition, aortic cross-clamp time (OR 1.007, p = 0.002) and maximal vasoactive–inotropic score in the first 48 hours (OR 1.03, p = 0.04) were associated with post-operative arrhythmias.

Conclusion:

Body mass index is independently associated with incidence of post-operative arrhythmias in children after CHD surgery.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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