And we’re not talking about money for a change
The results of new research into heart surgery outcomes appear to turn current thinking on its head.
Patients who are overweight or obese are less likely to die in hospital after a heart operation than those who are a healthy weight, a study has found.
The results of the British Heart Foundation (BHF)-funded research suggest it is wrong to deny people surgery because they are overweight and that underweight patients could benefit from gaining weight prior to a heart operation.
A team at the University of Leicester collected data on about 400,000 adults in the UK and Ireland who underwent cardiac surgery between 2002 and 2013, categorising them into different weight categories, according to their BMI (body mass index).
Of those included, 11,511 patients died in hospital, including 4.4% of patients who were of healthy weight, compared with only 2.8% of those who were overweight and 2.7% in obese class I (with a BMI of 30 to 35). The study, published on Friday in the journal Circulation, found that 8.5% of patients who were underweight died in hospital.
The authors believe the study confirms the existence of the much-debated obesity paradox, whereby obesity can cause illnesses, such as heart disease or a heart attack but at the same time have certain protective effects.
Leading the team Professor Gavin Murphy said they found a linear association between increasing BMI and lower risk of acute heart failure or acute stroke but the relationship did not hold for all adverse outcomes post-surgery (infections, for example). How being overweight or obese protects patients who undergo surgery is unknown but the researchers plan to investigate this in future.
The researchers found that overweight or obese patients had greater protection regardless of age and even if they had experienced complications associated with obesity, such as hypertension, diabetes and coronary artery disease.
They also reviewed data from 557,720 further patients included in studies across Europe, the United States and Asia, finding similar results.
These new findings emerge against a background of policy-making by many NHS groups to place restrictions on access to surgery for overweight people.
It may be that the practical reasons for ‘rationing’ surgeries – that obese people are less likely to recover – is speculative and best or maybe even spurious.
The irony that introduces a moral element into the decision is that it will be their obesity that causes many of the patients to require the surgery in the first place.
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