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Medical Versus Surgical ICU Obese Patient Outcome

A Propensity-Matched Analysis to Resolve Clinical Trial Controversies

De Jong, Audrey, MD1–3; Verzilli, Daniel, MD1; Sebbane, Mustapha, MD, PhD1,2; Monnin, Marion, MD1; Belafia, Fouad, MD1; Cisse, Moussa, MD1; Conseil, Matthieu, MD1; Carr, Julie, MD1; Jung, Boris, MD, PhD1–3; Chanques, Gérald, MD, PhD1–3; Molinari, Nicolas, PhD3,4; Jaber, Samir, MD, PhD1–3

doi: 10.1097/CCM.0000000000002954
Online Clinical Investigations
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Objectives: To determine the short- and long-term mortality of obese ICU patients following medical as opposed to surgical admission and the relation between obesity and mortality.

Design: Retrospective analysis of prospectively collected data, using a propensity score–matched analysis of patients with medical or surgical admission.

Setting: One French mixed medical-surgical ICU.

Patients: Critically ill obese patients (body mass index ≥ 30 kg/m2) and nonobese patients admitted during a 14-year period.

Interventions: None.

Measurements and Main Results: Seven-hundred ninety-one obese patients and 4,644 nonobese patients were included, 338 (43%) and 2,367 (51%) medical and 453 (57%) and 2,277 (49%) surgical obese and nonobese patients, respectively. Mortality was significantly higher in medical than in surgical obese patients in ICU (25% vs 12%; p < 0.001) and up to 365 days (36% vs 18%; p < 0.001) post ICU admission. One-to-one propensity score matching generated 260 pairs with well-balanced baseline characteristics. After matching on propensity score, mortality was still significantly higher in medical patients both in the ICU (21% vs 13%; p = 0.03) and up to 365 days (30% vs 20%; p = 0.01) post ICU admission. Obesity was not significantly associated with mortality both in univariate analysis (140 obese patients [15%] in the dead group vs 651 [14%] in the alive group; p = 0.72) and multivariate analysis (odds ratio, 1.09 [95% CI, 0.86–1.38]; p = 0.49) after adjustment for Simplified Acute Physiology Score II, age, category of admission, history of cardiac disease, and history of respiratory disease.

Conclusions: After careful matching, the data suggest that ICU mortality in obese population was higher in the medical group than in the surgical group and remains significantly higher 365 days post ICU admission.

1Intensive Care Unit and Department of Anesthesiology, University of Montpellier Saint-Eloi Hospital, Montpellier, France.

2Department of Emergency Medicine, CHRU Montpellier, Hôpital Lapeyronie, Montpellier, France.

3INSERM U1046, CNRS UMR 9214, Montpellier, France.

4Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 729 MISTEA, Montpellier, France.

This study was performed at University of Montpellier, Montpellier University Hospital.

Drs. De Jong and Verzilli equally contributed to this study. Drs. De Jong, Verzilli, and Jaber contributed to the conception and design of the study, to the analysis and interpretation of data, to drafting the submitted article, and to provide final approval of the version to be published. Dr. Sebbane contributed to the acquisition of the data, to the analysis of the data, to drafting the submitted article, and to provide final approval of the version to be published. Drs. Monnin, Belafia, M. Cisse, and M. Conseil contributed to the acquisition of the data and to provide final approval of the version to be published. Dr. Carr contributed to the acquisition of data and drafting the submitted article. Dr. Jung contributed to the acquisition of the data and to provide final approval of the version to be published. Dr. Chanques contributed to the acquisition of the data and to provide final approval of the version to be published. Dr. Molinari contributed to the analysis and interpretation of data and to provide final approval of the version to be published.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by institutional and/or departmental sources (Institutional University Hospital of Montpellier, 34000, France).

Dr. Jaber declares interest conflicts with societies Dräger, Hamilton, Maquet, and Fisher & Paykel. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: s-jaber@chu-montpellier.fr

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