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

Miller, Michael S.; Kang, Martin; Cornwall, James C.; Png, C.Y. Maximilian; Marin, Michael L.; Faries, Peter L.; Tadros, Rami O.

doi:10.1016/j.avsg.2018.10.025

Cited by 20 publications

(11 citation statements)

References 23 publications

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“…They showed significantly improved survival rates for overweight patients up to 10 years after EVAR. 19 Similarly, Davenport et al reported lower mortality rates after vascular surgery in patients with mild obesity. 4 Galfos et al reported a 2.5-fold increase in wound infections in obese patients than non-obese patients in their study conducted on all vascular surgical procedures.…”

Section: Discussionmentioning

confidence: 94%

The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

et al. 2021

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Background Obesity is a common and growing health problem in vascular surgery patients, as it is in all patient groups. Evidence regarding body mass index (BMI) on endovascular aneurysm repair (EVAR) outcomes is not clear in the literature. We aimed to determine the impact of obesity on perioperative and midterm outcomes of elective EVAR between obese and non-obese patients. Methods Under a retrospective study design, a total of 120 patients (109 males, 11 females, mean age: 74.45 ± 8.59 (53–92 years)) undergoing elective EVAR between June 2012 and May 2020 were reviewed. Patients were stratified into two groups: obese (defined as a body mass index (BMI) ≥ 30 kg/m2) and non-obese (mean BMI < 30 kg/m2 (32.25 ± 1.07 kg/m2 vs 25.85 ± 2.69 kg/m2)). Results Of the 120 patients included in the study, 81 (67.5%) were defined as “nonobese,” while 39 (32.5%) were obese. The mean BMI of the study group was 27.93 ± 3.78 kg/m2. In obese patients, the procedure time, fluoroscopy time, and dose area product (DAP) values were longer than those of non-obese patients: 89.74 ± 20.54 vs 79.69 ± 28.77 min ( p = 0.035), 33.23 ± 10.14 vs 38.17 ± 8.61 min ( p = 0.01) and 133.69 ± 58.17 vs 232.56 ± 51.87 Gy.cm2 ( p < 0.001). Although there was no difference in sac shrinkage at 12-month follow-up, there was a significant decrease at 6-month follow-up in both groups ( p = 0.017). Endoleak occurred in 17.9% ( n = 7) of the obese group versus 11.1% ( n = 9) of the non-obese group ( p = 0.302). Iliac branch occlusion developed in four patients, 3 (3.7%) in the non-obese group and 1 (2.6%) in the obese group ( p = 0.608). The all-cause mortality rate was slightly higher in the obese group; however, it did not differ between the groups ( p = 0.463). Conclusion In addition to the longer procedure times, fluoroscopy times, and DAP values in obese patients, regardless of obesity, significant sac shrinkage in the first 6 months of follow-up was observed in both groups. No difference was documented with regards to mortality or morbidity following EVAR.

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Section: Discussionmentioning

confidence: 94%

The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

et al. 2021

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“…Other authors have concentrated on the effects of BMI on either OSR or endovascular repair. 2 3 10 11 21 23 25 26 In this study, we have pooled data from OSR and endovascular repair as the decision to employ either technique should be made based on numerous variables by a multidisciplinary team on a case-by-case basis. Although the results from such studies may be more useful in considering the effects of obesity on a single repair type, pooling results allows for a more robust, real-world conclusion.…”

Section: Discussionmentioning

confidence: 99%

“…The “obesity paradox” has been widely studied in vascular surgery, specifically on abdominal aortic aneurysm (AAA) repair. 1 2 3 4 The paradox's main dictum is that the body mass index (BMI; mass (kg)/height (kg) 2 )-mortality curve is typically “U-shaped” with patients who are at the extremes of BMI being more likely to die. 5 6 Other studies, however, have shown no correlation between obesity (i.e., BMI > 30) and all-cause mortality; and a third group has shown decreased mortality in individuals with a raised BMI.…”

Section: Introductionmentioning

confidence: 99%

New Measures, Old Conclusions: Obesity Does Not Worsen Outcomes after Elective Abdominal Aortic Aneurysm Repair

et al. 2022

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Background The “obesity paradox,” whereby the body mass index (BMI) mortality curve is “U-shaped,” is a well-studied phenomenon in vascular surgery. However, there has been an overreliance on BMI as the measure of obesity, which has shown to poorly correlate with clinical outcomes. Robust measures such as waist-hip ratio (WHR) have been suggested as a more accurate marker reflecting central obesity. Objectives The objectives of this study were to evaluate the correlation between BMI and WHR on postoperative morbidity and mortality after elective abdominal aortic aneurysm (AAA) repair. Methods Data were collected from the Leeds Vascular Institute between January 2006 and December 2016. The primary outcome was mortality and secondary outcomes included length of stay (LOS) and all-cause readmission. Binary logistic regression, linear regression, and correlation analysis were used to identify associations between BMI and WHR in relation to outcome measures. Results After exclusions, 432 elective AAA repairs (281 open surgical repair [OSR] and 151 endovascular aneurysm repairs [EVARs]) were identified to be eligible for the study. The combined 30-day and 4-year mortality was 1.2 and 20.1%, respectively. The 30-day readmission rate was 3.9% and the average LOS was 7.33 (standard deviation 18.5) days. BMI data was recorded for 275 patients (63.7%) and WHR for 355 patients (82.2%). Logistic regression analysis highlighted no association between BMI and WHR with mortality, readmission, or LOS following OSR or EVAR. Conclusion The results of this study suggest patients should not be denied treatment for AAA based on obesity alone.

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“…Whether obesity is associated with improved survival after RAAA is controversial in the literature. 40–47 However, multiple studies suggest that obese patients with RAAA have improved outcomes with EVAR compared to open repair. 40,43 Studies suggest that increased frailty and decreased BMI often go hand in hand, and while in a chronic setting, obesity is hazardous, in an acute event such as rAAA, high albumin, and good nutritional in obese patients compared to frail patients could provide survival benifit.…”

Section: Discussionmentioning

confidence: 99%

Endograft type and anesthesia mode are associated with mortality of endovascular aneurysm repair for ruptured abdominal aortic aneurysms

et al. 2020

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Objective Endovascular aneurysm repair has become the primary treatment modality for ruptured infrarenal abdominal aortic aneurysm. This study examines the impact of endograft type on perioperative outcomes for ruptured infrarenal abdominal aortic aneurysm. Method The targeted endovascular aneurysm repair files of the American College of Surgeons National Surgical Quality Improvement Program database (2012–2017) were used. Only patients treated for ruptured infrarenal abdominal aortic aneurysm were included. All patients requiring concomitant stenting of the visceral arteries or aneurysmal iliac arteries or open abdominal surgery were excluded. The characteristics of patients treated with the different endografts and the corresponding outcomes were compared using Stata software. Results There were 479 patients treated with the three most common endografts: Cook Zenith ( n = 127), Gore Excluder ( n = 239), and Medtronic Endurant ( n = 113). The number of other endografts was too small for statistical analysis. Compared to patients treated with Excluder or Endurant, the patients treated with Zenith had significantly lower body mass index ( P < .001) and were less likely to be white ( P < .001). On the other hand, patients treated with Endurant were less likely to be smoker ( P = .016). Patients treated with Zenith had significantly larger ruptured infrarenal abdominal aortic aneurysm diameter ( P = .045). The overall mortality was 18% and morbidity 74.3%. There was a statistically significant difference in overall mortality (Zenith = 11.8%, Excluder = 18%, Endurant = 24.8%, P = .033) but not morbidity ( P = .808) between the three groups. Post hoc analysis for overall mortality showed only significant difference between Zenith and Endurant. The difference in mortality was not significant in patients presenting with ruptured infrarenal abdominal aortic aneurysm without hypotension ( P = .065). On multivariable analysis, treatment with the Endurant endograft was associated with increased mortality compared to Zenith (odds ratio = 3.0 [confidence interval 1.31–6.7]). General anesthesia (odds ratio = 2.67 [confidence interval 1.02–7.02]), rupture with hypotension (odds ratio = 4.49 [confidence interval 2.54–7.95]), and dependent functional status (odds ratio = 5.7 [confidence interval 1.96–16.59]) were independently associated with increased mortality while increasing body mass index (odds ratio = 0.97 [confidence interval 0.95–0.99]) was associated with reduced risk of mortality. Conclusions This study highlights contemporary outcomes of endovascular aneurysm repair for ruptured infrarenal abdominal aortic aneurysm with relatively low mortality. Endograft type and anesthesia technique are modifiable factors that can potentially improve outcomes. Significant variation in the outcomes of the different endografts warrants further research.

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

Cited by 20 publications

References 23 publications

The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

New Measures, Old Conclusions: Obesity Does Not Worsen Outcomes after Elective Abdominal Aortic Aneurysm Repair

Endograft type and anesthesia mode are associated with mortality of endovascular aneurysm repair for ruptured abdominal aortic aneurysms

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