High BMI Associated With Lower Likelihood of Being Discharged Home After Hospitalization for Stroke

March 2007: Individuals with a higher body mass index (BMI) tend are less likely to be discharged directly home after hospitalization for an ischemic stroke, according to a report in the March issue of Archives of Neurology, one of the JAMA/Archives journals.

An ischemic stroke occurs when the flow of blood to a part of the brain is blocked or reduced and sufficient amounts of oxygen cannot be delivered to brain tissue. Obesity and excess weight are risk factors for stroke and may influence outcome or increase the likelihood of complications among stroke patients, according to background information in the article.

Tannaz Razinia and colleagues at UCLA Medical Center, Los Angeles, analyzed the relationship between BMI and discharge outcomes in 451 patients with ischemic stroke admitted to a university hospital stroke service between 2003 and 2006. Patients were divided into four groups based on their BMI. "Patients with a BMI of 35 or greater represented class II obesity; those with a BMI of 30 to 34, class I obesity; those with a BMI of 25 to 29, overweight; and those with a BMI of less than 25, lean," the authors write.

The average age of the patients was 65 and 28 percent were men. Patients in the highest BMI category were significantly less likely to be discharged directly home (compared with transfer to inpatient rehabilitation setting, general medicine service or skilled nursing facility) than those in the lowest BMI category (26 percent vs. 45 percent).

The highest two BMI categories showed a statistically nonsignificant trend toward extended length of hospital stay when compared with the lowest BMI category (6.3 days vs. 5.2 days). "Eighteen of the 451 patients died and in-hospital mortality did not differ among the BMI groups," the authors note. "No significant differences in the functional activity outcome were noted across BMI categories."

"In summary, this study suggests that hospitalized obese individuals may have poorer discharge clinical outcomes than their leaner counterparts," the authors conclude. "Future studies are required to confirm these results and to identify the pathophysiologic mechanisms at play. In the interim, our study provides further impetus for identifying and appropriately treating obese individuals at risk for first and recurrent stroke."

This study was supported in part by an award from the National Institutes of Health, part of the National Institute of Neurological Disorders and Stroke. Arch Neurol. 2007;64:388-391

Source: American Medical Association (AMA)