Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective
Ahmed Alnajar, MD, MSPH,
Kelley N. Benck, BS,
Tawseef Dar, MD,
Sameer A. Hirji, MD, MPH,
Walid Ibrahim, MD,
Brian Detweiler, MS,
Venkat Vuddanda, MD, MS,
Raymond Balise, PhD,
J. Sunil Rao, PhD,
Min Lu, PhD,
Joseph Lamelas, MD
Affiliations
Ahmed Alnajar, MD, MSPH
Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla; Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla; Address for reprints: Ahmed Alnajar, MD, MSPH, Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, 1295 NW 14th St, Suite J, Miami, FL 33125.
Kelley N. Benck, BS
Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
Tawseef Dar, MD
Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
Sameer A. Hirji, MD, MPH
Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
Walid Ibrahim, MD
Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
Brian Detweiler, MS
Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
Venkat Vuddanda, MD, MS
Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
Raymond Balise, PhD
Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
J. Sunil Rao, PhD
Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
Min Lu, PhD
Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
Joseph Lamelas, MD
Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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 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 (body mass index ≥40), 55% were women, 66% underwent elective surgery, and 55% received isolated open mitral valve replacement or repair. In-hospital mortality was 5.0% (n = 2430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.43), higher Elixhauser comorbidity score (aOR, 2.10; 95% CI, 1.87-2.36), prior valve surgery (aOR, 1.63; 95% CI, 1.01-2.63), and more than 2 concomitant procedures (aOR, 2.83; 95% CI, 2.07-3.85). Lower mortality was associated with elective admissions (aOR, 0.70; 95% CI, 0.56-0.87) and valve repair (aOR, 0.58; 95% CI, 0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, body mass index ≥40, and kidney failure. Conclusions: The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in patients undergoing open mitral valve replacement or repair. 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.
