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CC BY 4.0 · Aorta (Stamford) 2022; 10(01): 020-025
DOI: 10.1055/s-0042-1742699
Original Research Article

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

Joshua John Sommerville Wall 
1   Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
2   Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, West Yorkshire, United Kingdom
,
Katie F. Boag 
2   Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, West Yorkshire, United Kingdom
,
Mohammed A. Waduud
1   Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
,
Keleabetswe Pabale
1   Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
,
Benjamin Wood
2   Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, West Yorkshire, United Kingdom
,
Marc Bailey
1   Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
3   Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
,
Julian A. Scott
1   Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
2   Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, West Yorkshire, United Kingdom
› Author Affiliations Funding None.
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Abstract

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.

Keywords

abdominal aortic aneurysm - AAA - obesity - mortality - elective


Publication History

Received: 21 January 2021

Accepted: 30 August 2021

Article published online:
31 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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