Print this pageOutcomes Of Lower Extremity Arterial Revascularization In Obese Patients
Virendra I Patel, Chantel Hile, Frank B Pomposelli, Jr., Marc L Schermerhorn, Sherry D Scovell, David R Campbell, Frank W LoGerfo, Allan D Hamdan
Beth Israel Deaconess Medical Center, Boston, MA
Objectives:
Obesity and associated co-morbidities are associated with a high rate of complications and technical difficulties after a number of surgical procedures. We studied the role of obesity on outcomes in lower extremity arterial revascularization.
Methods:
We reviewed all lower extremity arterial revascularizations performed at our institution in 2000. Body mass index (BMI) greater than or equal to thirty defined obesity. Perioperative outcomes, long-term survival and graft patency were evaluated in obese and non-obese patients using Fisher’s exact t-test and Kaplan Meier analysis.
Results:
The study population consisted of 73 (25.8%) obese and 210 (74.2%) non-obese patients. Patient demographics of the obese and non-obese populations showed no statistical differences. The mean BMI for obese patients was 34.5±4.7 kg/m2 and in non-obese patients BMI was 24.6±3.2. The mean age of each group was 66.9±9.9 (BMI≥30) and 69.6±12.6 (BMI<30). There were 44 (60.2%) obese men and 23 (39.8%) women. There were 129 (61.4%) non-obese men and 81 (38.6%) women. Diabetes was present in 75.3% of obese and 70.5% of non-obese patients. Peri-operative myocardial infarction, 30-day mortality and rate of re-operation within 30 days were not significantly different. Obese patients were found to have a higher 24-hour post-operative fluid balance (2530±1550 v. 1990±1300; p=0.005), increased length of stay (8.3±10.6 vs. 6.5±5.4; p=0.02) and increased postoperative wound infection rates (15.1% vs. 7.6%; p=0.026). During follow up, 13.7% of obese and 12.9% of non-obese patients underwent ipsilateral amputation (p=0.09). Survival analysis showed 79.7% and 84.7% one-year survival and 66.5% v. 62.2% 3-year survival in obese and non-obese patients (p=0.24), respectively. Kaplan Meier estimates showed no effect of obesity on long-term graft patency.
Conclusions:
Obese patients have similar limb salvage rates, perioperative cardiac morbidity and near term survival but have increased wound infections and length of stay.