Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection

Abstract

Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.

Impact of body mass index on perioperative mortality of acute stanford type A aortic dissection: a systematic review and meta-analysis

“…Moreover, 2 independent retrospective cohort studies in Japan [ 7 , 8 ] and 1 in Italy [ 22 ] identified obesity (BMI ≥ 30.0) as a risk factor of in-hospital mortality in ATAAD patients who underwent surgical repairs (OR = 3.00, 95% CI: 1.40–6.20, OR = 3.16, 95% CI: 1.48–6.74, and OR = 2.14, 95% CI: 1.22–3.78). However, a retrospective cohort study conducted in Germany [ 9 ] and 2 in China [ 10 , 24 ] found no associations.…”

“…Some studies reported that obesity raised the risk of perioperative mortality of ATAAD [ 7 , 8 ]. However, other studies failed to demonstrate a significant association between body mass index (BMI) and perioperative mortality of ATAAD [ 9 , 10 ]. Relatively low sample size and single-center design of most previous studies may contribute to controversial conclusions.…”

Obesity and acute type A aortic dissection: unraveling surgical outcomes through the lens of the upper hemisternotomy approach

“…For example, employing wound care protocols designed for patients with diminished tissue repair mechanisms, as well as personalized postoperative nutritional plans to promote recovery. This underlines the efficacy of the surgical approach and postoperative management, suggesting that while obesity presents certain complexities, they can be adeptly managed with the right surgical strategy and postoperative care (21,22).…”

Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study

“…But the mortality was similar to previous reports in our center. [ 36 ] The mortality between 2 groups has no significant difference.…”