The Effects of Increasing Obesity on Outcomes of Vascular Surgery

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Conclusion: Vascular procedures on morbidly obese patients require longer operating times and have higher rates of infection, but this does not translate into worse final outcomes. Summary: Worldwide, there are at least 300 million obese patients and 1 billion adults who are overweight. Obesity contributes to increased health care cost and increased deaths; however, the effect of obesity on perioperative morbidity and mortality, especially in vascular surgical patients, is not well established. The authors sought to determine whether a body mass index (BMI) >35 kg/m2 (morbid obesity) affects the morbidity and mortality of patients undergoing vascular surgery. The study took place in the United Kingdom, where men reportedly are in the highest quintile of obesity in Europe and women are in the second highest. The data were collected for index vascular procedures of carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, and infrainguinal bypass. The database encompassed procedures from 1996 to 2006. BMI was stratified into <18.5 kg/m2 and >35 kg/m2. Patients with intermittent BMI (range, 18.5-35 kg/m2) were used as controls. Length of operation, length of stay, complications, and mortality rates were analyzed. There was adjustment for confounding variables, including diabetes, cardiac history, renal function, and smoking as well as mode of admission to the hospital. There were 1317 patients reviewed, and 1105 were considered suitable for analysis. Morbid obesity increased from 1.3% to 9% during the 10-year study period. Operation duration was longer for morbidly obese patients compared with those of normal weight; however, this was only statistically significant for AAA repairs. Infection was also increased in the morbidly obese patients; again, however, statistical significance was only reached in the AAA cases (43.5% vs 34.8%, P < .004). Morbid obesity did not appear to result in a significant difference in other complications such as graft failure, length of stay, or death. Comment: Everyone recognizes the additional technical challenges of performing surgery in the morbidly obese. The lifelong health effects of morbid obesity are clearly adverse, but it does not appear, from this study, that operative times or perioperative morbidity and death are significantly increased by morbid obesity in the vascular surgical patient, with the exception of operative times and infection in the AAA patients. Although it is more difficult to operate on the obese patient, the presence of obesity itself does not appear to be a valid reason to deny a patient an indicated vascular procedure.