Impact of Obesity on Outcomes after Aortic Arch Repair with Circulatory Arrest: A National, Multicenter Analysis
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0157
Submission Type:
Abstract Submission
Authors:
Malak Elbatarny (1), Areeba Zubair (2), Maral Ouzounian (3), Jennifer Chung (4), John Bozinovski (5), Michael Moon (6), Bindu Bittira (7), Rony Atoui (8), Kevin Lachapelle (9), Munir Boodhwani (10), Francois Dagenais (11), Jonathan Hong (12), Matthew Valdis (13), Michael Chu (14), Canadian Thoracic Aortic Collaborative Investigators (15)
Institutions:
(1) TGH / St Michael's, Toronto, ON, (2) St. Michael's Hospital, University of Toronto, Toronto, Ontario, (3) Toronto General Hospital, Toronto, ON, (4) Toronto General Hospital, Toronto, Ontario, (5) Ohio State University Wexner Medical Center, Columbus, OH, (6) University of Alberta, Edmonton, NA, (7) N/A, N/A, (8) Northern Ontario School of Medicine, Sudbury, ON, (9) Division of Cardiac Surgery, McGill University Health Centre, Montreal, QC, (10) N/A, Ottawa, ON, (11) Quebec Heart and Lung Insitute, Quebec, Quebec, (12) Max Rady College of Medicine, University of Manitoba, Winnipeg, NA, (13) N/A, London, ON, (14) University Hospital, London Health Sciences Centre, London, Canada, (15) Western University, London, NA
Submitting Author:
Malak Elbatarny
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TGH / St Michael's
TGH / St Michael's
Co-Author(s):
Areeba Zubair
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St. Michael's Hospital, University of Toronto
St. Michael's Hospital, University of Toronto
*Maral Ouzounian
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Toronto General Hospital
Toronto General Hospital
Jennifer Chung
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Toronto General Hospital
Toronto General Hospital
John Bozinovski
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Ohio State University Wexner Medical Center
Ohio State University Wexner Medical Center
Michael Moon
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University of Alberta
University of Alberta
Bindu Bittira
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N/A
N/A
Rony Atoui
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Northern Ontario School of Medicine
Northern Ontario School of Medicine
Kevin Lachapelle
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Division of Cardiac Surgery, McGill University Health Centre
Division of Cardiac Surgery, McGill University Health Centre
*Munir Boodhwani
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N/A
N/A
*Francois Dagenais
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Quebec Heart and Lung Insitute
Quebec Heart and Lung Insitute
Jonathan Hong
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Max Rady College of Medicine, University of Manitoba
Max Rady College of Medicine, University of Manitoba
Matthew Valdis
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N/A
N/A
*Michael Chu
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University Hospital, London Health Sciences Centre
University Hospital, London Health Sciences Centre
Canadian Thoracic Aortic Collaborative Investigators
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Western University
Western University
Presenting Author:
Malak Elbatarny
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TGH / St Michael's
TGH / St Michael's
Abstract:
Objective: Obesity has been reported to have variable effects on outcomes after surgery. In aortic operations, obesity may increase technical complexity, heating/cooling duration, duration of circulatory arrest, and impair recovery, however evidence is lacking. We therefore sought to the determine impact of overweight and obesity on perioperative risk of patients undergoing surgery with circulatory arrest.
Methods: We retrospectively reviewed all patients undergoing aortic arch repair with circulatory arrest (N=2256) from 9 centers (2002-2021). After excluding those without available BMI data, those undergoing thoracoabdominal incisions, and a minority of underweight patients, 2128 individuals remained. Subgroup analyses were performed for patients undergoing elective and acute type A dissection repairs. Primary outcomes were in hospital death and hospital length of stay. Secondary outcomes included perioperative complications. Linear regression was performed to determine the association of weight parameters with perfusion parameters. Multivariable logistic regression was also performed for death and prolonged hospital length of stay (defined as >15 days, 3rd quartile).
Results: Considering the total cohort, 27% patients were of ideal weight (BMI 18.5-24.9, n=571), 42% were overweight (BMI 25-29.9, n=885), and 31% were obese (BMI ≥ 30, n=672). Significant differences were observed in age [ideal: 64.0±14, overweight: 63.8±13, obese: 61.2±12.3 years p<0.001] and proportion of males [ideal: 59% (n=336), overweight: 76% (n=668), obese: 74% (n=495) years p<0.001]. Additionally, obese patients had the smallest proportion of acute dissections [ideal: 35% (n=197), overweight: 35% (n=307), obese: 28% (n=189), p=0.012]. No differences were observed in proportion of patients undergoing concomitant aortic valve replacement, Bentall procedure, valve sparing, extended arch procedures, or overall aortic cross clamp durations. Modest but statistically significant correlations were observed between weight and total CPB [weight vs total CPB: R=0.2, P<0.001]. In the unadjusted comparison of the overall cohort, no differences were observed in risk of death, stroke, re-exploration for bleeding, ventilation ≥ 40h, sepsis, or mediastinitis. However, hospital length of stay was significantly greater among ideal weight patients [ideal: 9 [IQR:6-16] overweight: 8 [IQR:6-14] obese: 8 [IQR:6-13] p<0.001, Figure 1A]. After adjusting for baseline differences, death remained similar between groups, and hospital length of stay remained significantly in favor of increased weight [overweight OR: 0.75 (95%CI: 0.61-0.93) p= 0.03; obese OR: 0.74 (95%CI: 0.58-0.93) p= 0.03; Figure 1B-C]. Adjusted risk of death was significantly higher among obese individuals in the type A dissection subgroup [OR: 2.55 (1.56 – 4.18, p=0.002, Figure 1B].
Conclusions: Most aortic surgery patients are overweight or obese. Similar complexity of operations as ideal weight patients are performed. While perioperative risk of death among obese and overweight patients is similar to that of ideal weight patients, obesity is independently associated with reduced hospital length of stay. These data suggest that the obesity paradox may prevail in aortic surgery for all comers. Obese patients have excess mortality from type A dissection. Obesity should not preclude patients from aortic surgery with circulatory arrest, however caution should be taken in type A dissection.
Methods: We retrospectively reviewed all patients undergoing aortic arch repair with circulatory arrest (N=2256) from 9 centers (2002-2021). After excluding those without available BMI data, those undergoing thoracoabdominal incisions, and a minority of underweight patients, 2128 individuals remained. Subgroup analyses were performed for patients undergoing elective and acute type A dissection repairs. Primary outcomes were in hospital death and hospital length of stay. Secondary outcomes included perioperative complications. Linear regression was performed to determine the association of weight parameters with perfusion parameters. Multivariable logistic regression was also performed for death and prolonged hospital length of stay (defined as >15 days, 3rd quartile).
Results: Considering the total cohort, 27% patients were of ideal weight (BMI 18.5-24.9, n=571), 42% were overweight (BMI 25-29.9, n=885), and 31% were obese (BMI ≥ 30, n=672). Significant differences were observed in age [ideal: 64.0±14, overweight: 63.8±13, obese: 61.2±12.3 years p<0.001] and proportion of males [ideal: 59% (n=336), overweight: 76% (n=668), obese: 74% (n=495) years p<0.001]. Additionally, obese patients had the smallest proportion of acute dissections [ideal: 35% (n=197), overweight: 35% (n=307), obese: 28% (n=189), p=0.012]. No differences were observed in proportion of patients undergoing concomitant aortic valve replacement, Bentall procedure, valve sparing, extended arch procedures, or overall aortic cross clamp durations. Modest but statistically significant correlations were observed between weight and total CPB [weight vs total CPB: R=0.2, P<0.001]. In the unadjusted comparison of the overall cohort, no differences were observed in risk of death, stroke, re-exploration for bleeding, ventilation ≥ 40h, sepsis, or mediastinitis. However, hospital length of stay was significantly greater among ideal weight patients [ideal: 9 [IQR:6-16] overweight: 8 [IQR:6-14] obese: 8 [IQR:6-13] p<0.001, Figure 1A]. After adjusting for baseline differences, death remained similar between groups, and hospital length of stay remained significantly in favor of increased weight [overweight OR: 0.75 (95%CI: 0.61-0.93) p= 0.03; obese OR: 0.74 (95%CI: 0.58-0.93) p= 0.03; Figure 1B-C]. Adjusted risk of death was significantly higher among obese individuals in the type A dissection subgroup [OR: 2.55 (1.56 – 4.18, p=0.002, Figure 1B].
Conclusions: Most aortic surgery patients are overweight or obese. Similar complexity of operations as ideal weight patients are performed. While perioperative risk of death among obese and overweight patients is similar to that of ideal weight patients, obesity is independently associated with reduced hospital length of stay. These data suggest that the obesity paradox may prevail in aortic surgery for all comers. Obese patients have excess mortality from type A dissection. Obesity should not preclude patients from aortic surgery with circulatory arrest, however caution should be taken in type A dissection.
Aortic Symposium:
Aortic Arch
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