The Effect Of Body Mass Index On Outcomes After Carotid Endarterectomy
Nkiruka J. Arinze, M.D., Alik Farber, Tyler Ryan, Scott Levin, Thomas Cheng, Douglas Jones, Denis Rybin, Jeffrey Siracuse.
Boston University, Boston, MA, USA.
OBJECTIVES: Patients who are obese or underweight are traditionally at higher risk for perioperative morbidity and mortality. The effect of body mass index (BMI) on outcomes after carotid endarterectomy (CEA) is unclear. Our goal was to analyze the association of BMI status with perioperative and long-term outcomes after elective CEA.
METHODS: Using the Vascular Quality Initiative database, we performed a retrospective analysis of outcomes after CEA. The population was stratified into 5 BMI groups - underweight (UW, BMI<18.5), normal weight (NW, BMI 18.5-24.9), overweight (OW, BMI 25-29.9), obese (OB, BMI 30-39.9), morbidly obese (MO, BMI>40). Perioperative and long-term outcomes were assessed with multivariable analysis and Kaplan Meier analysis. Subset analysis was performed for patients who had symptomatic cerebrovascular disease at the time of CEA.
RESULTS: There were 89,079 patients included: 2% UW, 26% NW, 38.4% OW, 29.9% OB, and 3.6% MO. In multivariable analysis, MO was associated with an increased risk of perioperative cardiac complications (OR 1.29, 95% CI 1.03-1.61, P=.03) and UW with return to operating room (OR) for bleeding (OR 1.89, 95% CI 1.28-2.78, P=.001). There were no differences in perioperative stroke, cranial nerve injury, or mortality. UW was associated with increased 5-year mortality (HR 1.2, 95% CI 1.05 - 1.39, P=.007). In a subgroup analysis of symptomatic patients (18.9%), UW group had an increased association with return to OR for bleeding (OR 2.83, 1.31-6.13, P=.008) and 5-year mortality (OR 1.45, 95% CI 1-2.09, P=.05).
CONCLUSIONS: BMI status was not associated with perioperative stroke or death; however, MO was associated with increased risk of perioperative cardiac complications. UW patients have lower long-term survival both overall and in the symptomatic subgroup. More work is needed to achieve long-term risk reduction in this population.
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