Abstract WMP41: Risk of 1 Month Stroke, Adverse Events and Mortality following Carotid Endarterectomy (CEA) According to Body Mass Index, Analysis of National Surgical Quality Improvement Program (NSQIP) Registry

Abstract

Background: Carotid revascularization procedures are increasingly performed in overweight and obese patients. However, whether such procedures are associated with a higher risk of peri-procedural complications is not known. Methods: We studied all patients who underwent CEA in the CEA targeted American College of Surgeons (ACS) NSQIP Registry between years 2011 and 2013. The ACS-NSQIP prospectively collects data on over 300 variables pertaining to patient characteristics, comorbidities, operative details and 30 day post-operative outcomes. Patients were divided into four groups according to body mass index (BMI in kg/m 2 ): underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (30-39.9) and morbidly obese (≥40). The odds ratios for selected outcomes were calculated after adjusting for age, gender and symptomatic status using logistic regression. Results: Among the 8576 patients who underwent CEA, 117, 2251, 3339, 2569 and 300 patients were underweight, normal weight, overweight, obese and morbidly obese. Compared with normal weight patients, the risk of stroke within 30 days was not different in overweight (1.6% vs. 2.2%; p=0.17), obese (1.6% vs. 2.4%; p=0.07) and morbidly obese patients (1.6% vs. 1.7%; p>0.999). Compared with normal weight patients, the risk of mortality within 30 days was not different in overweight (0.8% vs. 1.0%; p=0.43) and morbidly obese patients (0.7% vs. 1.0%; p>0.999) but was significantly lower in obese patients (0.5% vs. 1.0%; p=0.04). The one month stroke and/or mortality was not higher in overweight (OR: 1.16; 95% CI: 0.83-1.64; p=0.38), obese (OR: 1.06; 95% CI: 0.88-1.28; p=0.53) and morbidly obese patients (OR: 1.06; 95% CI: 0.81-1.40; p=0.65) after adjusting for potential confounders. There were no differences in the rates of adverse events such as myocardial infarction/arrhythmia, acute renal failure and unplanned intubations according to BMI strata while need for blood transfusions was significantly lower in overweight (2.1% vs. 3.7%; p<0.001) and obese (1.6% vs. 3.7%; p<0.001) patients as compared to normal weight. Conclusions: CEA can be performed with similar rates of stroke, adverse events and mortality in obese and morbidly obese patients as those observed in normal weight patients.