News | Endovascular Aortic Repair | November 21, 2018

Obese Patients Have More Post-Op Problems Following AAA Repair

Study finds obese patients have higher rates of renal failure and wound infection after endovascular abdominal aortic aneurysm repair

Obese Patients Have More Post-Op Problems Following AAA Repair

November 21, 2018 — New research in the December edition of the Journal of Vascular Surgery suggests significant increase in morbidities in obese patients after open surgery, but not after endovascular abdominal aortic aneurysm (AAA) repair.1

Researchers found that obese patients were more likely to have longer procedures and to lose more blood than those who were not obese, and obese patients were more likely to have post-operative problems such as renal failure or wound infections.

In this new study, researchers from Johns Hopkins University, led by vascular surgeon Mahmoud Malas, M.D., performed a retrospective analysis of prospectively collected data by the Vascular Quality Initiative (2003-2017). The aim of the study was comparing in-hospital outcomes in obese (body mass index >30) vs non-obese patients undergoing AAA repair.

“In this large national sample of an elective AAA cohort,” said Malas, “obese patients had similar in-hospital mortality compared with non-obese patients in both open and endovascular repairs. The results remained unchanged even after looking at different subclasses of obesity, including those with BMI >40.”

Previous work defining early outcomes after AAA in the obese has yielded conflicted results. Recent meta-analysis suggested the superiority of endovascular repair over open, but only four studies with relatively small numbers were included. Single-center studies have either corroborated this conclusion or failed to demonstrate a difference.

The new study ultimately evaluated 33,082 procedures including both:

  • Open repair (non-obese, n=4,604, obese, n=1,754); and

  • Endovascular repair (non-obese, n=18,338, obese, n=8,385).

Demographic analysis revealed that the obese patients, compared to the non-obese, were:

  • Younger (67.6 vs 70.3 years old);

  • Male (open repair, 76 percent vs 73 percent, endovascular repair, 82 percent vs 81 percent); and

  • More likely to have significant comorbid conditions (diabetes, hypertension, coronary artery disease, and congestive heart disease).

Evaluation of the operations revealed that the obese had:

  • Higher blood loss (open, 2,030 vs 1,617ml, endovascular 228 vs 207ml); and

  • Longer operations (open 259 vs 239 mins, endovascular 138 vs 134 mins).

With regards to outcomes, there was no difference in mortality between the groups for either repair method (open 3 percent vs 3 percent, endovascular 0.5 percent vs 0.6 percent).

However, following open repair, the obese patients had higher odds of developing:

  • Renal failure (1.33 odds ratio); and

  • Wound infection (1.75 odds ratio).

“Wound infection is a common complication seen among obese patients undergoing all surgical procedures. Even after adjusting for comorbid conditions, the obese had 75 percent higher odds of wound infection following open repair, with the highest rates observed in the more severely obese patients,” noted Malas.

“In this study open repair showed increased risk of all in-hospital complications compared with endovascular therapy for AAA,” Malas said, “corroborating the known superiority of endovascular repair over open repair seen in the literature.”

While weight reduction itself would be considered important, this is not always possible in cases where more urgent care is necessary, such as AAA. With the prevalence of significant obesity in the United States as high as 39.8 percent, understanding its impact on the outcomes of various medical procedures is key in delivering safe and cost-effective healthcare.

This research article is open source here through Jan. 31, 2019.

For more information: www.jvascsurg.org

Reference

1. Locham S., Rizwan M., Dakour-Aridi H., et al. Outcomes after elective abdominal aortic aneurysm repair in obese versus nonobese patients. Journal of Vascular Surgery, published online June 7, 2018. https://doi.org/10.1016/j.jvs.2018.03.414


Related Content

News | Cardiovascular Clinical Studies

March 13, 2023 — BioCardia, Inc., developer of cellular and cell-derived therapeutics for the treatment of ...

Home March 13, 2023
Home
News | Cardiovascular Clinical Studies

March 8, 2023 — A unique community-based partnership, the African American Heart Study, will be conducted to measure the ...

Home March 08, 2023
Home
News | Cardiovascular Clinical Studies

March 6, 2023 — A multifaceted intervention to improve prescribing practices increased the likelihood that patients with ...

Home March 06, 2023
Home
News | Cardiovascular Clinical Studies

March 5, 2023 — Providing medications for chronic diseases—for example, cholesterol-lowering, blood pressure and ...

Home March 05, 2023
Home
News | Cardiovascular Clinical Studies

March 5, 2023 — The number of deaths and disabling strokes among patients at low surgical risk who were treated with ...

Home March 05, 2023
Home
News | Cardiovascular Clinical Studies

March 5, 2023 — In the largest randomized trial conducted to compare minimally invasive and conventional cardiac ...

Home March 05, 2023
Home
News | Cardiovascular Clinical Studies

February 20, 2023 — Esperion announced that the landmark Cholesterol Lowering via Bempedoic acid, an ACL-Inhibiting ...

Home February 20, 2023
Home
News | Cardiovascular Clinical Studies

February 16, 2023 — Traffic noise may play an essential role in the development and deterioration of ischemic heart ...

Home February 16, 2023
Home
News | Cardiovascular Clinical Studies

February 8, 2023 — Life Molecular Imaging (LMI) announced that the first patient has been imaged with [18F]florbetaben ...

Home February 08, 2023
Home
News | Cardiovascular Clinical Studies

January 26, 2023 — A newly-released study extends the understanding of how acquired mutations in blood cells act as a ...

Home January 26, 2023
Home
Subscribe Now