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Objective
The rising incidence of morbid obesity is especially relevant to vascular surgeons. The purpose of this study was to compare morbidly obese patients with the general population for rates of revascularization in the setting of peripheral vascular disease (PVD) and identify comorbidities and demographic variables related to morbid obesity within this population.
Methods
The Nationwide Inpatient Sample database was used to identify hospitalizations associated with PVD from 2005-2009. Rates of percutaneous and open revascularization were compared between morbidly obese and non-morbidly obese patients. For patients undergoing revascularization, multivariate logistic regression was used to identify variables independently associated with morbid obesity. Post-procedure complications were analyzed, and subgroup analysis was performed for specific complications of PVD, including claudication, rest pain, ulceration and gangrene.
Results
During the study period there were 600,799 hospital admissions during which a revascularization procedure was performed for PVD. Morbidly obese patients within this group were significantly younger (median age 57 y.o. vs. 65 y.o., p<0.0005). Multivariate logistic regression identified variables independently associated with morbid obesity, including diabetes (OR 3.94-4.30), congestive heart failure (OR 2.15-3.10), chronic kidney disease (OR 1.19-1.36), Caucasian race (OR 1.08-1.17) and lowest income quartile (OR 1.05-1.15). Negatively associated variables with morbid obesity include age over 60 (OR 0.40-0.44), smoking (OR 0.78-0.88), coronary artery disease (OR 0.75-0.83), highest income quartile (OR 0.84-0.94), and public insurance (OR 0.72-0.79).
Morbidly obese patients with rest pain or claudication were less likely to undergo revascularization procedures (68.1% vs. 72.3%, p<0.0005 and 58.4% vs. 60.9%, p<0.0005). They had higher rates of wound complications and infections for both percutaneous and open approaches. Finally, morbidly obese patients with ulceration or gangrene were less likely to undergo amputation compared to non-morbidly obese patients (8.9% vs. 16.5%, p<0.0005).
Conclusions
The morbidly obese population requires intervention for PVD at a younger age than the general population, independent of other comorbidities including diabetes. However, they are less likely to undergo revascularization and are half as likely to undergo major amputation. Those undergoing revascularization have significant differences from the general population with regards to age, medical comorbidities,
and household income. Further study is warranted to determine the cause of these disparities.