The Association Between Body Mass Index and Death Following Elective Endovascular and Open Repair of Abdominal Aortic Aneurysms in the Vascular Quality Initiative

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D'Oria, MarioTrieste Univ Hosp ASUIGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy.;Univ Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Str Fiume 447, Trieste, TS, Italy. (author)

The Association Between Body Mass Index and Death Following Elective Endovascular and Open Repair of Abdominal Aortic Aneurysms in the Vascular Quality Initiative

Article/chapterEnglish2023

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Elsevier BV,2023
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LIBRIS-ID:oai:DiVA.org:uu-510723
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-510723URI
https://doi.org/10.1016/j.ejvs.2023.01.047DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Objective: The effect of body mass index (BMI) on post-operative outcomes after abdominal aortic aneurysm (AAA) repair remains poorly defined. The association between BMI and death following elective endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) of AAA in a large national quality registry is investigated.Methods: All elective AAA repairs within the Society for Vascular Surgery Vascular Quality Initiative (VQI; 2010 to September 2021) were reviewed (EVAR, n = 53 426; OAR, n = 9 479). All analyses were conducted separately for EVAR and OAR patients. The primary end points were 30 day mortality and five year survival rates. Study cohorts were divided into World Health Organisation BMI categories (C1 < 18.5, C2 18.5 <= BMI < 25, C3 25 <= BMI < 30, C4, 30 <= BMI < 35, C5 35 <= BMI < 40, C6 >= 40). BMI was examined as both a categorical and continuous variable. Logistic and Cox proportional hazards regression were used for risk adjustment.Results: Among EVAR patients, BMI distribution was C1, 1 216 (2%); C2, 14 687 (28%); C3, 20 516 (38%); C4, 11 352 (21%); C5, 3 947 (7%); C6, 1 708 (3%). Class 1, 2, and 6 BMI patients experienced an increased 30 daymortality rate (C1 2.6%; C2 1.3%; C6 1.4% vs. C3 - 5 0.7%; p < .001) and C1 and C2 had correspondingly inferior long termsurvival (five years: C1 69 +/- 3%; C2 79 +/- 1% vs. C3 - 6 86 - 88 +/- 2%; log rank p <.001). These survival disparities persisted after risk adjustment formultiple confounders. In the OAR cohort, BMI distribution was C1, 280 (3%); C2, 2 862 (30%); C3, 3 587 (38%); C4, 1 940 (21%); C5, 581 (6%); C6, 229 (2%). Crude 30 day mortality rates were increased for both the lowest and highest BMI patients (C1 12%, C6 7% vs. C2 - 5 3 - 4%; p < .001); these differences also persisted in long term survival (five years: C1 71 +/- 6%, C6 82 +/- 6% vs. C2 - 6 85 - 88 +/- 3%; log rank p <.001). In risk adjusted analysis, both low and high BMI OAR patients had an increased 30 day and long term mortality rate.Conclusion: Within the VQI, both the extreme low (< 18.5) and high (>= 40) BMI groups experienced an increased 30 day mortality rate after both elective EVAR and OAR. By comparison, while the lowest BMI cohort was significantly associated with decreased long term survival after both procedures, the highest BMI group only experienced reduced long termsurvival after OAR. Based upon this large real world registry analysis of elective AAA repairs, differential metabolic signatures exist within extreme BMI categories, which may inform peri-operative risk stratification and clinical decision making.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
Aortic aneurysm
Body mass index
Endovascular repair
Mortality
Open repair
Outcomes

Added entries (persons, corporate bodies, meetings, titles ...)

Scali, SalvatoreUniv Florida, Div Vasc Surg & Endovasc Therapy, Gainesville, FL USA. (author)
Neal, DanUniv Florida, Div Vasc Surg & Endovasc Therapy, Gainesville, FL USA. (author)
DeMartino, RandallMayo Clin, Gonda Vasc Ctr, Div Vasc & Endovasc Surg, Rochester, MN USA. (author)
Mani, Kevin,1975-Uppsala universitet,Kärlkirurgi(Swepub:uu)kevma940 (author)
Budtz-Lilly, JacobAarhus Univ Hosp, Dept Cardiovasc Surg, Div Vasc Surg, Aarhus, Denmark. (author)
Lepidi, SandroTrieste Univ Hosp ASUIGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy. (author)
Stone, David H.Dartmouth Hitchcock Med Ctr, Sect Vasc Surg, Lebanon, NH USA. (author)
Trieste Univ Hosp ASUIGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy.;Univ Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc & Endovasc Surg, Str Fiume 447, Trieste, TS, Italy.Univ Florida, Div Vasc Surg & Endovasc Therapy, Gainesville, FL USA. (creator_code:org_t)

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In:European Journal of Vascular and Endovascular Surgery: Elsevier BV66:1, s. 27-361078-58841532-2165

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By the author/editor: D'Oria, Mario; Scali, Salvatore; Neal, Dan; DeMartino, Randa ...; Mani, Kevin, 197 ...; Budtz-Lilly, Jac ...; show more...; Lepidi, Sandro; Stone, David H.; show less...

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By the university: Uppsala University

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