Abstract
Background The “obesity paradox,” whereby the body mass index (BMI) mortality curve is “U-shaped,”
is a well-studied phenomenon in vascular surgery. However, there has been an overreliance
on BMI as the measure of obesity, which has shown to poorly correlate with clinical
outcomes. Robust measures such as waist-hip ratio (WHR) have been suggested as a more
accurate marker reflecting central obesity.
Objectives The objectives of this study were to evaluate the correlation between BMI and WHR
on postoperative morbidity and mortality after elective abdominal aortic aneurysm
(AAA) repair.
Methods Data were collected from the Leeds Vascular Institute between January 2006 and December
2016. The primary outcome was mortality and secondary outcomes included length of
stay (LOS) and all-cause readmission. Binary logistic regression, linear regression,
and correlation analysis were used to identify associations between BMI and WHR in
relation to outcome measures.
Results After exclusions, 432 elective AAA repairs (281 open surgical repair [OSR] and 151
endovascular aneurysm repairs [EVARs]) were identified to be eligible for the study.
The combined 30-day and 4-year mortality was 1.2 and 20.1%, respectively. The 30-day
readmission rate was 3.9% and the average LOS was 7.33 (standard deviation 18.5) days.
BMI data was recorded for 275 patients (63.7%) and WHR for 355 patients (82.2%). Logistic
regression analysis highlighted no association between BMI and WHR with mortality,
readmission, or LOS following OSR or EVAR.
Conclusion The results of this study suggest patients should not be denied treatment for AAA
based on obesity alone.
Keywords
abdominal aortic aneurysm - AAA - obesity - mortality - elective
