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Association Between Obesity, Age, and Functional Decline in Survivors of Cardiac Surgery.

ABSTRACT: BACKGROUND/OBJECTIVES:Little is known about the effect of obesity on functional decline after cardiac surgery, especially in elderly adults. Our goal was to determine the association between obesity and functional decline in the 2 years after cardiac surgery and the interaction between obesity and age. DESIGN:Retrospective cohort study. SETTING:The Health and Retirement Study, 2004-2014. PARTICIPANTS:U.S. adults aged 50 and older who indicated having cardiac surgery and had a body mass index (BMI) of 18.5 kg/m2 or greater (N = 1,731). MEASUREMENTS:BMI was classified as normal or overweight (18.5-29.9 kg/m2 ) and obese (?30 kg/m2 ). Primary outcome was decline in ability to perform an activity of daily living (ADL) after surgery. RESULTS:Respondents had a median age of 71, 59.3% were female, and 34.3% were obese. Obese respondents had a higher incidence of ADL decline (22.4%) than those who were not obese (17.1%) (P = .007). In the multivariable analysis of our full cohort, obesity was not associated with ADL decline (odds ratio (OR)=1.20, 95% confidence interval (CI)=0.90-1.59, P = .21) after cardiac surgery, although obese respondents aged 50 to 79 had greater odds of ADL decline (OR=1.45, 95% CI=1.06-2.00, P = .02). Obese respondents aged 80 and older had nonstatistically significantly lower odds of ADL decline (OR=0.61, 95% CI=0.30-1.24, P = .18) compared to non-obese respondents. CONCLUSION:The association between obesity and postoperative functional decline in survivors of cardiac surgery differed according to age. Additional research is needed to identify interventions to improve outcomes in groups of older adults in whom obesity may increase the risk of postoperative functional decline.

SUBMITTER: Gaulton TG

PROVIDER: S-EPMC5777886 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Association Between Obesity, Age, and Functional Decline in Survivors of Cardiac Surgery.

Gaulton Timothy G TG Neuman Mark D MD

Journal of the American Geriatrics Society 20171108 1

<h4>Background/objectives</h4>Little is known about the effect of obesity on functional decline after cardiac surgery, especially in elderly adults. Our goal was to determine the association between obesity and functional decline in the 2 years after cardiac surgery and the interaction between obesity and age.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>The Health and Retirement Study, 2004-2014.<h4>Participants</h4>U.S. adults aged 50 and older who indicated having cardiac surgery ...[more]

PMID: 29114877

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Project description:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:Cardiac surgery is associated with cognitive decline and postoperative delirium. The relationship between postoperative delirium and cognitive decline after cardiac surgery is unclear WHAT THIS ARTICLE TELLS US THAT IS NEW:The development of postoperative delirium is associated with a greater degree of cognitive decline 1 month after cardiac surgery. The development of postoperative delirium is not a predictor of cognitive decline 1 yr after cardiac surgery. BACKGROUND:Delirium is common after cardiac surgery and has been associated with morbidity, mortality, and cognitive decline. However, there are conflicting reports on the magnitude, trajectory, and domains of cognitive change that might be affected. The authors hypothesized that patients with delirium would experience greater cognitive decline at 1 month and 1 yr after cardiac surgery compared to those without delirium. METHODS:Patients who underwent coronary artery bypass and/or valve surgery with cardiopulmonary bypass were eligible for this cohort study. Delirium was assessed with the Confusion Assessment Method. A neuropsychologic battery was administered before surgery, at 1 month, and at 1 yr later. Linear regression was used to examine the association between delirium and change in composite cognitive Z score from baseline to 1 month (primary outcome). Secondary outcomes were domain-specific changes at 1 month and composite and domain-specific changes at 1 yr. RESULTS:The incidence of delirium in 142 patients was 53.5%. Patients with delirium had greater decline in composite cognitive Z score at 1 month (greater decline by -0.29; 95% CI, -0.54 to -0.05; P = 0.020) and in the domains of visuoconstruction and processing speed. From baseline to 1 yr, there was no difference between delirious and nondelirious patients with respect to change in composite cognitive Z score, although greater decline in processing speed persisted among the delirious patients. CONCLUSIONS:Patients who developed delirium had greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed.

Dataset Information

Association Between Obesity, Age, and Functional Decline in Survivors of Cardiac Surgery.

Publications

Association Between Obesity, Age, and Functional Decline in Survivors of Cardiac Surgery.

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