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The Impact of Obesity on Outcomes in Patients Receiving Extracorporeal Life Support.

Research paper by Nathaniel N Christian-Miller, Joseph J Hadaya, Morcos M Nakhla, Yas Y Sanaiha, Josef J Madrigal, Sara S Emami, Mario M Cale, Sohail S Sareh, Peyman P Benharash

Indexed on: 13 Jun '20Published on: 13 Jun '20Published in: Artificial Organs



Abstract

Extracorporeal life support (ECLS) is increasingly used to manage cardiac and pulmonary dysfunction. The impact of obesity on outcomes of ECLS is poorly defined. In this study, we aimed to examine in-hospital mortality, resource use, complications, and readmissions in obese versus nonobese patients receiving ECLS. A retrospective cohort study of all adult ECLS patients with and without an obesity diagnosis was performed using the 2010-16 Nationwide Readmissions Database (NRD). Mortality, length of stay (LOS), hospital charges, complications, and readmissions were evaluated using multivariable logistic and linear regression. Of 23,876 patients who received ECLS, 1,924 (8.1%) were obese. Obese patients received ECLS more frequently for respiratory failure (29.5% vs. 23.7%, P=0.001). After adjustment for patient and hospital factors, obesity was not associated with increased odds of mortality (AOR=1.06, P=0.44) and was associated with decreased LOS (13.7 vs. 21.2 days, P<0.001), hospital charges ($171,866 vs. $211,445, P<0.001), and 30-day readmission (AOR=0.71, P=0.03). Obesity was also associated with reduced odds of hemorrhage (AOR=0.43, P<0.001), neurologic complications (AOR=0.55, P=0.004), and acute kidney injury (AOR=0.83, P=0.04). After stratification by ECLS indication, obesity remained predictive of shorter LOS (AOR range: 0.53-0.78, all P<0.05) and did not impact mortality (all P>0.05). Respiratory support is the most common indication for extracorporeal support among obese patients. Among all patients, as well as by individual ECLS indication, obesity was not associated with increased odds of mortality. These findings suggest that obesity should not be considered a high-risk contraindication to ECLS. This article is protected by copyright. All rights reserved.