Off-pump coronary artery bypass grafting attenuates morbidity and mortality for patients with low and high body mass index

Background Patients at high and low body mass index have been shown to experience higher morbidity and mortality when undergoing coronary artery bypass grafting. The purpose of this research was to compare outcomes of patients at body mass index extremes who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. Methods A retrospective review of 6801 patients with a body mass index 35 undergoing isolated, primary coronary artery bypass grafting from 1996 to 2009 at Emory Healthcare Hospitals was performed. Patients were compared by therapy either on-pump coronary artery bypass grafting (n = 3210) or off-pump coronary artery bypass grafting (n = 3591). Salvage patients or those with concomitant operations were excluded. Comparisons were made using multivariable regression analysis, using a propensity score covariate calculated from 41 preoperative risk factors. Results A total of 6801 patients, including 4312 with a body mass index 35 (off-pump coronary artery bypass grafting, n = 1127; on-pump coronary artery bypass grafting, n = 1362) were included for analysis. Society of Thoracic Surgeons predicted risk of mortality was significantly higher for both body mass index strata in patients undergoing off-pump coronary artery bypass grafting (2.8% vs 3.1% for body mass index P  = .043] and 1.7% vs 1.8% for body mass index >35 [ P  = .049]). For patients with a body mass index P > .05). Conclusions Patients with high and low body mass indices experience reduced morbidity and in-hospital mortality when undergoing off-pump coronary artery bypass grafting. Despite a higher risk profile, patients with a body mass index