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The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality.
J Vasc Surg. 2009 Jan; 49(1):140-7, 147.e1; discussion 147.JV

Abstract

OBJECTIVE

Mild obesity may have a protective effect against some diseases, termed an "obesity paradox." This study examined the effect of body mass index (Kg/m(2) BMI) on surgical 30-day morbidity and mortality in patients undergoing vascular surgical procedures.

METHODS

As part of the National Surgical Quality Improvement Program (NSQIP), demographic and clinical risk variables, mortality, and 22 defined complications (morbidity) were obtained over three years from vascular services at 14 medical centers. At each medical center, patients from the operative schedule were prospectively and systematically enrolled according to NSQIP protocols. Outcomes and risk variables were compared across NIH-defined obesity classes (underweight [BMI<or=18.5], normal [18.5<BMI<25], overweight [25<BMI<or=30], obese I [30<BMI<or=35], obese II [35<BMI<or=40], and obese III [BMI>40]) using analysis of variance and means comparisons. Logistic regression was used to control for other risk factors.

RESULTS

Vascular procedures in 7,543 patients included lower extremity revascularization (24.6%), aneurysm repair (17.4%), cerebrovascular procedures (17.3%), amputations (9.4%), and "other" procedures (31.3%). In the entire cohort, there were 1,659 (22.0%) patients with complications and 295 (3.9%) deaths. Risk factors of hypertension and diabetes increased with BMI (analysis of variance [ANOVA] P < .05) as expected; smoking, disseminated cancer, and stroke decreased (ANOVA P < .01). Twenty other risk factors, as well as mortality and morbidity, had "U" or "J"-shaped distributions with the highest incidence in underweight and/or obese class III extremes but reduced minimums in overweight or obese I classes (ANOVA P < .05). After controlling for age, gender, and operation type, mortality risk remained lowest in obese class I patients (Odds ratio [OR] 0.63, P = .023) while morbidity risk was highest in obese class III patients (OR 1.70, P = .0003), due to wound infection, thromboembolism, and renal complications.

CONCLUSION

Underweight patients have poorer outcomes and class III obesity is associated with increased morbidity. Mildly obese patients have reduced co-morbid illness, surprisingly even less than normal-class patients, with correspondingly reduced mortality. Mild obesity is not a risk factor for 30-day outcomes after vascular surgery and confers an advantage.

Authors+Show Affiliations

Department of Surgery, University of Kentucky, Lexington, KY 40536-0298, USA. Daniel.Davenport@uky.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

19028047

Citation

Davenport, Daniel L., et al. "The Influence of Body Mass Index Obesity Status On Vascular Surgery 30-day Morbidity and Mortality." Journal of Vascular Surgery, vol. 49, no. 1, 2009, pp. 140-7, 147.e1; discussion 147.
Davenport DL, Xenos ES, Hosokawa P, et al. The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg. 2009;49(1):140-7, 147.e1; discussion 147.
Davenport, D. L., Xenos, E. S., Hosokawa, P., Radford, J., Henderson, W. G., & Endean, E. D. (2009). The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. Journal of Vascular Surgery, 49(1), 140-7, e1; discussion 147. https://doi.org/10.1016/j.jvs.2008.08.052
Davenport DL, et al. The Influence of Body Mass Index Obesity Status On Vascular Surgery 30-day Morbidity and Mortality. J Vasc Surg. 2009;49(1):140-7, 147.e1; discussion 147. PubMed PMID: 19028047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. AU - Davenport,Daniel L, AU - Xenos,Eleftherios S, AU - Hosokawa,Patrick, AU - Radford,Jacob, AU - Henderson,William G, AU - Endean,Eric D, Y1 - 2008/11/22/ PY - 2008/06/06/received PY - 2008/08/06/revised PY - 2008/08/08/accepted PY - 2008/11/26/pubmed PY - 2009/2/20/medline PY - 2008/11/26/entrez SP - 140-7, 147.e1; discussion 147 JF - Journal of vascular surgery JO - J Vasc Surg VL - 49 IS - 1 N2 - OBJECTIVE: Mild obesity may have a protective effect against some diseases, termed an "obesity paradox." This study examined the effect of body mass index (Kg/m(2) BMI) on surgical 30-day morbidity and mortality in patients undergoing vascular surgical procedures. METHODS: As part of the National Surgical Quality Improvement Program (NSQIP), demographic and clinical risk variables, mortality, and 22 defined complications (morbidity) were obtained over three years from vascular services at 14 medical centers. At each medical center, patients from the operative schedule were prospectively and systematically enrolled according to NSQIP protocols. Outcomes and risk variables were compared across NIH-defined obesity classes (underweight [BMI<or=18.5], normal [18.5<BMI<25], overweight [25<BMI<or=30], obese I [30<BMI<or=35], obese II [35<BMI<or=40], and obese III [BMI>40]) using analysis of variance and means comparisons. Logistic regression was used to control for other risk factors. RESULTS: Vascular procedures in 7,543 patients included lower extremity revascularization (24.6%), aneurysm repair (17.4%), cerebrovascular procedures (17.3%), amputations (9.4%), and "other" procedures (31.3%). In the entire cohort, there were 1,659 (22.0%) patients with complications and 295 (3.9%) deaths. Risk factors of hypertension and diabetes increased with BMI (analysis of variance [ANOVA] P < .05) as expected; smoking, disseminated cancer, and stroke decreased (ANOVA P < .01). Twenty other risk factors, as well as mortality and morbidity, had "U" or "J"-shaped distributions with the highest incidence in underweight and/or obese class III extremes but reduced minimums in overweight or obese I classes (ANOVA P < .05). After controlling for age, gender, and operation type, mortality risk remained lowest in obese class I patients (Odds ratio [OR] 0.63, P = .023) while morbidity risk was highest in obese class III patients (OR 1.70, P = .0003), due to wound infection, thromboembolism, and renal complications. CONCLUSION: Underweight patients have poorer outcomes and class III obesity is associated with increased morbidity. Mildly obese patients have reduced co-morbid illness, surprisingly even less than normal-class patients, with correspondingly reduced mortality. Mild obesity is not a risk factor for 30-day outcomes after vascular surgery and confers an advantage. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/19028047/The_influence_of_body_mass_index_obesity_status_on_vascular_surgery_30_day_morbidity_and_mortality_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(08)01405-5 DB - PRIME DP - Unbound Medicine ER -