Obesity is not an Independent Risk Factor for Adverse Perioperative and Long-Term Clinical Outcomes Following Open AAA Repair or EVAR

Park, Brian; Dargon, Phong; Binette, Christopher; Babic, Bruna; THOMAS, T. TURNER; Divinagracia, Thomas; Dahn, Michael S.; Menzoı́an, James O.

doi:10.1177/1538574411415427

Cited by 22 publications

(18 citation statements)

References 27 publications

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“…Both findings held true across our univariate and multivariate analyses. We also found that obese patients were significantly less likely to have sac shrinkage greater than 5 mm after EVAR, but that they, along with overweight 19,20 However, the interpretation of NSQIP data by Giles et al 15 on morbidly obese patients suggests that there are increased rates of wound infection after all aneurysm repair and increased mortality rates after OAR but not EVAR. Similarly, Johnson et al 12 demonstrated obesity was an independent predictor of wound complications after OAR and EVAR but not predictive of other complications or death.…”

Section: Discussionmentioning

confidence: 45%

The Impact of Body Mass Index on Perioperative and Postoperative Outcomes for Endovascular Abdominal Aneurysm Repair

Miller

Kang

Cornwall

et al. 2020

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 45%

The Impact of Body Mass Index on Perioperative and Postoperative Outcomes for Endovascular Abdominal Aneurysm Repair

Miller

Kang

Cornwall

et al. 2020

Annals of Vascular Surgery

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“…Clinical outcomes in patients with obesity may be impacted by numerous factors, including comorbid conditions, associated metabolic changes and any modifications in clinical care (including nutrition support) that are made on behalf of the obese patient. The available studies comparing outcomes of mortality, length of stay (LOS), and complications in obese ICU and non-ICU patients are limited by their retrospective database evaluation, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] by a relatively small number of obese subjects, [24][25][26][27][28][36][37][38][39][40][41] or by overall small sample size. 22,[24][25][26][27][28]31,34,[39][40][41][42][43] In particular, mortality outcomes are varied, depending on these factors.…”

Section: Question 1: Do Clinical Outcomes Vary Across Levels Of Obesimentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Choban

Dickerson

Malone

et al. 2013

J Parenter Enteral Nutr

136

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Background: Due to the high prevalence of obesity in adults, nutrition support clinicians are encountering greater numbers of obese patients who require nutrition support during hospitalization. The purpose of this clinical guideline is to serve as a framework for the nutrition support care of adult patients with obesity. Method: A systematic review of the best available evidence to answer a series of questions regarding management of nutrition support in patients with obesity was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process, that includes consideration of the strength of the evidence together with the risks and benefits to the patient, was used to develop the clinical guideline recommendations prior to multiple levels of external and internal review and approval by the A.S.P.E.N. Board of Directors. Questions: (1) Do clinical outcomes vary across levels of obesity in critically ill or hospitalized non−intensive care unit (ICU) patients? (2) How should energy requirements be determined in obese critically ill or hospitalized non‐ICU patients? (3) Are clinical outcomes improved with hypocaloric, high protein diets in hospitalized patients? (4) In obese patients who have had a malabsorptive or restrictive surgical procedure, what micronutrients should be evaluated?

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“…[22][23][24] In a study comparing percutaneous access versus cut-down in obese patients at Yale, there was a decreased overall rate of wound complications in the percutaneous group versus the cut-down group, with complications being defined as wound disruption, deep or superficial SSIs, or organ space SSIs (5.5 vs. 9.4%, p ¼ 0.039). 25 Renal failure was by far the most predictable risk factor with the greatest odds for wound complication (11.9% in wound complication patients vs. 2.5% without, OR ¼ 3.3, CI ¼ 0.033). This is an unsurprising finding considering renal failure is a well-known risk factor for infection due to its effects on overall impairment of immune function, through both decreased innate and adaptive immune responses and predisposition to inflammation.…”

Section: Discussionmentioning

confidence: 93%

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

et al. 2019

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We identified factors that would lead to wound complications after open femoral exposure for endovascular abdominal aortic aneurysm repair (oEVAR).Using the National Surgical Quality Improvement Program dataset (2005–2014), we examined the patients who underwent oEVAR. Patients were stratified on whether they developed postoperative wound complications. Comparisons were made between group with wound complications and those without and adjusted analyses performed to identify variables that independently increased the risk of wound complications.There were 14,868 patients in the study cohort and 2.6% (384 patients) developed wound complications after EVAR. Among those with wound complications, 94% (360 patients) of patients had superficial and deep surgical site infection. Patients who had wound complication were likely to be younger (72.6 vs. 73.7 years old (p = 0.02), functionally dependent (5.4 vs. 2.5%) (p < 0.05), smoker (3 vs. 2.4%, p =0.03), female (4 vs. 2.2%), with significantly higher body mass index (31 vs. 28), and more commonly had diabetes (4 vs. 2.4%, p < 0.001) or renal failure (12 vs. 3%, p < 0.001). Although perioperative survival was similar, patients who had wound complications had significantly longer hospital length of stay (LOS) (7.3 ± 12 vs. 3.4 ± 5 days, p < 0.001).Up to 3% patients developed wound complications after open femoral exposure during EVAR with significantly higher LOS and therefore cost utilization.

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Obesity is not an Independent Risk Factor for Adverse Perioperative and Long-Term Clinical Outcomes Following Open AAA Repair or EVAR

Cited by 22 publications

References 27 publications

The Impact of Body Mass Index on Perioperative and Postoperative Outcomes for Endovascular Abdominal Aneurysm Repair

The Impact of Body Mass Index on Perioperative and Postoperative Outcomes for Endovascular Abdominal Aneurysm Repair

A.S.P.E.N. Clinical Guidelines

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

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