Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective
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 unde...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623001122 |
| _version_ | 1797674155500371968 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Ahmed Alnajar, MD, MSPH |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T21:54:56Z |
| format | Article |
| id | doaj.art-a45e3b802a5c4ae69372efb271cbb2aa |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-11T21:54:56Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-a45e3b802a5c4ae69372efb271cbb2aa2023-09-26T04:12:27ZengElsevierJTCVS Open2666-27362023-09-0115127150Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspectiveAhmed Alnajar, MD, MSPH0Kelley N. Benck, BS1Tawseef Dar, MD2Sameer A. Hirji, MD, MPH3Walid Ibrahim, MD4Brian Detweiler, MS5Venkat Vuddanda, MD, MS6Raymond Balise, PhD7J. Sunil Rao, PhD8Min Lu, PhD9Joseph Lamelas, MD10Division 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.Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FlaDivision of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FlaDivision of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, MassDivision of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FlaDivision of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FlaDivision of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, MassDivision of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FlaDivision of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FlaDivision of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FlaDivision of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FlaObjective: 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.http://www.sciencedirect.com/science/article/pii/S2666273623001122adult cardiacobesitymitral valvemortalitymachine learningrandom forest |
| spellingShingle | 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 Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective JTCVS Open adult cardiac obesity mitral valve mortality machine learning random forest |
| title | Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective |
| title_full | Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective |
| title_fullStr | Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective |
| title_full_unstemmed | Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective |
| title_short | Predictors of outcomes in patients with obesity following mitral valve surgeryCentral MessagePerspective |
| title_sort | predictors of outcomes in patients with obesity following mitral valve surgerycentral messageperspective |
| topic | adult cardiac obesity mitral valve mortality machine learning random forest |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623001122 |
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