The Effect of Body Mass Index on Outcomes after Carotid Endarterectomy
Nkiruka Arinze M.D., Alik Farber M.D., Scott Levin, M.D., Thomas Cheng, M.S., Douglas W. Jones, M.D., Denis Rybin, Ph.D., Jeffrey J. Siracuse, M.D.
Background:
Patients who are overweight and underweight are traditionally at higher risk of 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 (VQI) 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.
Results:
There were 89,191 patients included: 2.1% UW, 26% NW, 38.3% OW, 29.9% OB, and 3.7% MO. There were differences among the BMI groups with regards age, sex, smoking status, and comorbidities (Table 1). For perioperative outcomes, groups differed significantly in 30-day mortality, new onset congestive heart failure, and return to the OR for bleeding. (Table 1) There were no significant differences among the BMI groups in the rates of stroke, overall cardiac events, cranial nerve injury. Multivariable analysis did not any association with BMI for stroke, 30-day mortality, and cranial nerve injury. MO was associated with an increased risk of perioperative cardiac complications (OR 1.29, 95% CI 1.03-1.61, P=.03). UW was associated with increased return to the OR for bleeding (OR 1.83, 95% CICI 1.25-2.68, P=.002) and 5-year mortality (HR 1.2, 95% CI 1.05 – 1.39, P = .007).
Conclusion:
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 and more work is needed to achieve long-term risk reduction in this population
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