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Obesity does not affect EVAR outcomes
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Obesity did not increase the odds of major adverse events in patients undergoing endovascular aneurysm repair, according to a review of a national database.
However, in patients undergoing open aortic repair, obesity was associated with increased risk for renal failure and wound infections.
The researchers identified 33,082 patients who underwent elective repair of an abdominal aortic aneurysm between 2003 and 2017 and were listed in the Vascular Quality Initiative database.
Among patients who underwent open repair, 27.6% were obese, defined as BMI of at least 30 kg/m2. Among patients who had EVAR, 31.4% were obese.
Patients with obesity were younger than nonobese patients in the open-repair cohort (68 years vs. 70 years; P < .001) and in the EVAR cohort (71 years vs. 75 years; P < .001). Women comprised 27% of nonobese patients who had open repair, 24% of patients with obesity who had open repair, 19% of nonobese patients who had EVAR and 18% of patients with obesity who had EVAR.
Outcomes of interest included in-hospital mortality and major complications, including renal failure, wound infection and cardiopulmonary failure.
In both procedure types, patients with obesity had longer procedure times and higher blood loss than nonobese patients (P < .001 for all), Satinderjit Locham, MD, from Johns Hopkins Bayview Vascular and Endovascular Research Center, and colleagues wrote.
There was no difference between obese and nonobese patients in in-hospital mortality in the open-repair cohort (obese, 2.9%; nonobese, 3.2%; P = .5) and in the EVAR cohort (obese, 0.5%; nonobese, 0.6%; P = .76).
When the researchers performed a multivariable analysis, they found that in the open-repair cohort, patients with obesity had higher odds of renal failure (adjusted OR = 1.33; 95% CI, 1.09-1.63) and wound infections (aOR = 1.75; 95% CI, 1.11-2.76) compared with nonobese patients.
However, in the EVAR cohort, there was no difference between the groups in odds of renal failure, wound infections or cardiopulmonary failure, the researchers wrote.
Patients with obesity had higher odds of renal failure if they had open repair compared with EVAR (OR for interaction = 1.36; 95% CI, 1.05-1.75), according to the researchers.
Open repair “demonstrated an increased mortality and morbidity compared with EVAR in both study groups, but the magnitude of the difference in many complications was higher in obese patients,” Locham and colleagues wrote. “Our study suggests that EVAR is the safer approach in these patients.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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