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The Obesity Paradox in Spontaneous Intracerebral Hemorrhage: Results from a Retrospective Analysis of the Nationwide Inpatient Sample

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Abstract

Background/objective

Mild obesity is associated with a survival benefit in cardiovascular and cerebrovascular disease. Only a few studies have analyzed the effect of obesity on outcomes after spontaneous intracerebral hemorrhage (ICH), and none have used a national US database. We sought to determine whether or not obesity was associated with outcomes and in-hospital complications following ICH.

Methods

The Nationwide Inpatient Sample was used to identify patients with ICH in the USA who were discharged between 2002 and 2011. The presence of obesity (body mass index [BMI] 30–39.9) or morbid obesity (BMI ≥ 40) was noted. The primary outcome of interest was in-hospital mortality, and secondary outcomes included non-routine discharge disposition, tracheostomy or gastrostomy placement, length of stay (LOS), inflation-adjusted hospital charges, and in-hospital complications.

Results

A total of 123,415 patients with ICH met the inclusion criteria, and the 10-year overall incidence of obesity was 4.5%. Between 2002 and 2011, the incidence of obesity increased from 1.9 to 4.4% and the incidence of morbid obesity increased from 0.7 to 3.2%. Both obese (OR 0.62, 95% CI 0.56–0.69) and morbidly obese (OR 0.76, 95% CI 0.66–0.88) patients had lower odds of inpatient mortality. Obese (OR 0.85, 95% CI 0.78–0.93) but not morbidly obese patients had lower odds of non-routine discharge. Morbidly obese patients were twice as likely to require a tracheostomy than non-obese patients (OR 2.07, 95% CI 1.62–2.66). Both obese and morbidly obese patients had higher total hospital charges and rates of pulmonary, renal, and venous thromboembolic complications. There was no difference in LOS according to body habitus.

Conclusions

In patients with spontaneous ICH, obesity is associated with decreased in-hospital mortality but higher rates of in-hospital complications and greater total hospital charges. Non-morbid obesity carries lower odds of non-routine hospital discharge.

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA

    Haydn Hoffman, Muhammad S. Jalal, Taylor Furst & Lawrence S. Chin

Authors
  1. Haydn Hoffman
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  2. Muhammad S. Jalal
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  3. Taylor Furst
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  4. Lawrence S. Chin
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Contributions

The manuscript complies with all instructions to authors. HH conceived of the study, performed data analysis, created the tables and figures, and drafted and revised the manuscript. MSJ assisted in drafting the manuscript and interpreting the data. TF performed data analysis and revised the manuscript. LSC supervised all stages of the study, interpreted the data, and critically revised the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Haydn Hoffman.

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The authors declare that they have no conflict of interest.

Ethical Approval

This study utilized an existing publicly available administrative database, and no additional data collection was performed. Therefore, Institutional Review Board approval and informed consent were not required.

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Supplementary Figure 1

Interactions between age and body habitus for (a) in-hospital mortality, (b) non-routine disposition, (c) tracheostomy placement, and (d) gastrostomy placement. (BMI: body mass index) (TIFF 423 kb)

Supplementary material 2 (DOCX 54 kb)

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Hoffman, H., Jalal, M.S., Furst, T. et al. The Obesity Paradox in Spontaneous Intracerebral Hemorrhage: Results from a Retrospective Analysis of the Nationwide Inpatient Sample. Neurocrit Care 32, 765–774 (2020). https://doi.org/10.1007/s12028-019-00796-3

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