Impact of Body Mass Index on Clinical Outcomes after Robotic Cardiac Surgery in Da Vinci: is There an Obesity Paradox?

Abstract

Abstract Objective：To analyze the safety and efficacy of Da Vinci robotic cardiac surgery, to investigate the effect of body mass index (BMI) on postoperative clinical outcomes, and to explore the postoperative obesity paradox. Methods：The data of 146 patients who underwent cardiac surgery under Da Vinci robotic cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (42.88±13.01) years, 55 (37.67%) were male and 91 (62.33%) were female. Patients were divided into 3 groups according to preoperative BMI: lean group (BMI<18.5 kg/m2; n=17; 11.64%), normal group (18.5 kg/m2≤BMI<23.9 kg/m2; n=81; 55.48%), and overweight and obese group (BMI≥24 kg/m2; n=48; 32.88%). Multivariate analysis was performed to compare clinical outcomes across BMI groups. Results：Preoperative data in different BMI groups showed that there were statistically significant differences in gender, height, weight, body surface area (BSA), diabetes, left atrial anteroposterior diameter (LAD), triglyceride (TG), high-density lipoprotein (HDL), and lymphocyte count (LY) (all P<0.05). Postoperative clinical outcomes showed that the risk of cardiac surgery-associated acute kidney injury (CSA-AKI) was significantly increased in the overweight and obese groups (P=0.021), and further multivariate binary logistic regression analysis suggested that preoperative TG (OR 1.772, 95%CI 1.068-2.942,P=0.027) and operation time ≥ 300 min (OR 3.823, 95%CI 1.098-13.308,P=0.035) were independent risk factors for postoperative CSA-AKI. Conclusion：Overweight and obese cardiac surgery is prone to CSA-AKI, which does not support the obesity paradox; preoperative TG and operation time≥300 min are independent risk factors for postoperative CSA-AKI.