Sage Journals: Discover world-class research

Abstract

Objective

The purpose of this study was to evaluate the impacts of obesity on patients undergoing aortobifemoral bypass for aortoiliac occlusive disease (AIOD). AIOD is an atherosclerotic disease of the suprainguinal arteries, and treatment approaches are often guided by the TASC II classification. The obesity paradox, a phenomenon where higher-than-normal BMI individuals exhibit better outcomes in various medical conditions, has yet to be fully understood in the context of AIOD.

Methods

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried for AIOD cases between January 1, 2011 and December 31, 2016. All patients included in the AIOD targeted files were eligible for inclusion unless their BMI was missing. Patient demographics and surgical characteristics were analyzed across BMI, categorized as underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9), obese (30–34.9), and very obese (≥35). Multivariable logistic and linear regression models, adjusting for demographics, comorbidities, and AIOD symptoms, were used to estimate the association between BMI and patient outcomes.

Results

Overall, 4885 patients met inclusion criteria, of which 274 (6%) patients were underweight, 1720 (35%) were normal weight, 1649 (32%) were overweight, 843 (16%) were obese, and 399 (8%) were very obese. Among all groups, neither age nor symptoms were significantly different. The functional status of the patients across all groups was also similar. Compared to normal-weight patients, obese and very obese patients were significantly more likely to be diabetic (34% and 50% vs 16%) and have hypertension (82% and 84% vs 5%), p < .0001. Both obese (OR 2.11, 95% CI 1.47, 3.04) and very obese patients (OR 2.94, 95% CI 1.95, 4.45) had significantly higher incidences of infection. Very obese patients also had a higher incidence of pneumonia (OR 2.03, 95% CI 1.11, 3.74) and prolonged ventilator requirement (OR 3.09, 95% CI 1.86, 5.14) compared to normal-weight patients. No differences were seen in mortality (p = .92) or length of stay (p = .20).

Conclusion

An elevated body mass index (BMI) is associated with a higher vulnerability to infection, pneumonia, and an extended need for ventilation after open aortobifemoral bypass surgery. However, there was no association between BMI and 30-day mortality or duration of hospitalization in patients who had AOBF bypass.

Keywords

Aortoiliac occlusive disease aortobifemoral bypass obesity aortoiliac occlusive disease open aortic repair

Get full access to this article

View all access options for this article.

References

Leriche

Morel

. The syndrome of thrombotic obliteration of the aortic bifurcation. Ann Surg 1948; 127: 193–206.

Sen

Stephen

Agarwal

. Clinical profile of aortoiliac occlusive disease and outcomes of aortobifemoral bypass in India. J Vasc Surg 2013; 57: 20S–25S.

McCready

Vincent

Schwartz

, et al. Atherosclerosis in the young: a virulent disease. Surgery 1984; 96: 863–869.

Norgren

Hiatt

Dormandy

, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45: S5–S67.

Smith

Beach

Dash

, et al. Comparison of aortobifemoral bypass to aortoiliac stenting with bifurcation reconstruction for TASC II D aortoiliac occlusive disease. Ann Vasc Surg 2022; 82: 120–130.

Pascarella

Aboul Hosn

. Minimally invasive management of severe aortoiliac occlusive disease. J Laparoendosc Adv Surg Tech 2018; 28: 562–568.

Giles

Wyers

Pomposelli

, et al. The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement Program, 2005-2007. J Vasc Surg 2010; 52: 1471–1477.

Lavie

Alpert

Arena

, et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail 2013; 1: 93–102.

Tsai

Choti

Assumpcao

, et al. Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: a large single-institution study. J Gastrointest Surg 2010; 14: 1143–1150.

10.

Davenport

Xenos

Hosokawa

, et al. The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg 2009; 49: 140–147.

11.

Giles

Hamdan

Pomposelli

, et al. Body mass index: surgical site infections and mortality after lower extremity bypass from the national surgical quality improvement Program 2005–2007. Ann Vasc Surg 2010; 24: 48–56.

12.

Valentijn

Galal

Tjeertes

EKM

, et al. The obesity paradox in the surgical population. Surgeon 2013; 11: 169–176.

13.

Locham

Rizwan

Dakour-Aridi

, et al. Outcomes after elective abdominal aortic aneurysm repair in obese versus nonobese patients. J Vasc Surg 2018; 68: 1696–1705.

14.

Salomon Du Mont

Mauny

Chrétien

, et al. Obesity is not an independent factor for adverse outcome after abdominal aortic aneurysm repair. Ann Vasc Surg 2016; 33: 67–74.

15.

Galyfos

Geropapas

Kerasidis

, et al. The effect of body mass index on major outcomes after vascular surgery. J Vasc Surg 2017; 65: 1193–1207.

16.

Ramachandran

Unkart

Willie-Permor

, et al. The obesity paradox exists for perioperative complications and mortality following lower extremity arterial bypass surgery. J Vasc Surg 2024; 80: 811–820. DOI: 10.1016/j.jvs.2024.04.044.

17.

Tanaka

Perlick

Miller

3rd , et al. Metabolic syndrome but not obesity adversely affects outcomes after open aortoiliac bypass surgery. Ann Vasc Surg 2018; 46: 155–161.

18.

Gil

María Aguilera

Gil-Campos

, et al. Altered signalling and gene expression associated with the immune system and the inflammatory response in obesity. Br J Nutr 2007; 98: S121–S126.

19.

Sutherland

McKinley

Eckel

. The metabolic syndrome and inflammation. Metab Syndr Relat Disord 2004; 2: 82–104.

20.

Mullen

Davenport

Hutter

, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 2008; 15: 2164–2172.

21.

Mullen

Moorman

Davenport

. The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 2009; 250: 166–172.

22.

Locham

Rizwan

Dakour-Aridi

, et al. Outcomes after elective abdominal aortic aneurysm repair in obese versus nonobese patients. J Vasc Surg 2018; 68: 1696–1705.

23.

Calligaro

Azurin

Dougherty

, et al. Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg 1993; 18: 914–921.

24.

Pasin

Nardelli

Belletti

, et al. Pulmonary complications after open abdominal aortic surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 2017; 31: 562–568.

25.

Owusu-Bediako

Pfaff

Tram

, et al. Association of severe obesity and chronic obstructive pulmonary disease with pneumonia following non-cardiac surgery. J Clin Med Res 2022; 14: 237–243.

26.

Khanna

Gbadegesin

Reline

, et al. Severe obesity and prolonged postoperative mechanical ventilation in elderly vascular surgery patients. J Clin Med Res 2022; 14: 341–347.

Effect of obesity on patient outcomes after aortobifemoral bypass in the treatment of aortoiliac occlusive disease

Abstract

Objective

Methods

Results

Conclusion

Keywords

Get full access to this article

References