Background
There is varying evidence regarding the effects of body mass index (BMI) on outcomes
of endovascular aneurysm repair (EVAR). This study investigates the effects of BMI
on an index of perioperative and postoperative outcomes after EVAR.
Methods
Four hundred ninety-two patients who underwent elective EVAR at Mount Sinai Hospital
were included in this study. Patients were classified as either normal weight (BMI = 18.5–25),
overweight (BMI = 25-30), or obese (BMI>30). Chi-squared tests were used to determine
significant differences between weight classes across an index of outcomes. The following
outcomes were collected: intraoperative complications (e.g., conversion to open),
perioperative complications (e.g., hematoma, bowel ischemia, and so forth), and postoperative
outcomes (endoleak, sac enlargement, sac shrinkage, access site infection, prolonged
postoperative length of stay, reintervention, stroke, claudication/lower extremity
ischemia, deep vein thrombosis, limb occlusion, renal complications, abdominal aortic
aneurysm (AAA) rupture, AAA-related mortality, and all-cause mortality). Kaplan-Meier
survival analysis and a log-rank test were used to determine meaningful differences
in all-cause mortality following EVAR between the respective weight classes. Subsequently,
multivariate Cox proportional hazards were performed for selection of outcomes, with
weight classes as predictors. Finally, a multivariate logistic regression was performed
for postoperative hospital stay. Subgroup multivariate analysis was also performed
examining only class I obese patients, rather than all obese patients.
Results
Overweight patients were significantly less likely to experience all-cause mortality
up to 9 years after EVAR than normal-weight patients in both Kaplan-Meier and multivariable
Cox proportional hazards models. Obese patients similarly had a lower risk of mortality
in Kaplan-Meier analysis, but this did not persist in the multivariate analysis. Overweight
patients were also significantly less likely to require a postoperative hospital stay
longer than 1 day when compared with normal-weight patients. Finally, obese patients
were less likely to have a sac shrinkage greater than 5 mm after EVAR, but were also
less likely to have an endoleak.
Conclusions
This study adds to the debate on the effects of BMI on outcomes of EVAR. Obesity was
not a risk factor for negative perioperative or postoperative outcomes after EVAR
with the exception of decreased sac shrinkage. Obese patients were less likely to
have an endoleak, and overweight patients were protected against all-cause mortality
and longer postoperative hospital stays.
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Article Info
Publication History
Published online: January 30, 2019
Accepted:
October 15,
2018
Received:
August 17,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
