Increased BMI Does Not Affect Complication Rate After Carotid Endarterectomy
Arthelma C. Tyson, MD, Celsa M. Tonelli, BS, Shailraj Parikh, MD, Amira Alkhatib, BS, Saqib Zia, MBBS, Kuldeep Singh, MD, Jonathan Deitch, MD, FACS, Jonathan Schor, MD, FACS.
Staten Island University Hospital, Staten Island, NY, USA.
Objective(s): Obese patients face increased surgical complication rates. We evaluated outcomes in patients undergoing carotid endarterectomy (CEA) based on their body mass index (BMI).
Methods: A single institution retrospective chart review of 300 consecutive CEAs from February 2011 to July 2015 was performed. Patient demographics, history, BMI, and post-operative results were evaluated. Patients were grouped into CDC categories of relative obesity based on BMI (underweight: < 18.5, normal: 18.5 to < 25, overweight: 25.0 to < 30, obese: 30.0 to < 40, severely obese: >40). Statistical analyses were used to compare demographics and outcomes of each group to those of the "normal BMI" group with Fischer's exact test and paired t-test respectively.
Results: The mean age was 70.2 years (42-92). 59% were male. Mean BMI was 28.1. Eight patients were underweight (2.7%), 70 were normal weight (23.3%), 129 were overweight (43%), 86 were obese (28.7%), and 7 were severely obese (2.3%). 92% had hypertension with no significant difference in prevalence between each group and the "normal BMI" group. 38% had diabetes. Diabetes was less prevalent in the "underweight" group (p< 0.05). The mean case durations were: underweight: 115.6 minutes (p = 0.99), normal: 119.7min, overweight: 120.4min (p = 0.35), obese: 127.2min (p = 0.31), severely obese: 119min (p=0.97). There was a trend toward longer operating times for obese patients, though not achieving statistical significance. There were no noted cases of intra-operative stoke, death, myocardial infarction, or perioperative PE. Re-intubation was required in 3 patients: 2 overweight, 1 obese. The obese patient also required hematoma evacuation and subsequently expired. This was the only perioperative death and the only hematoma requiring evacuation. Surgical site infection was noted in one patient (obese). 9 patients (3%) received post-operative blood transfusion with no significant difference in need for transfusion between groups. There were 2 post-operative strokes (0.6%), both patients were "overweight. " There was no significant difference in post-operative stroke among BMI groups. 6 patients (2%) had post-operative MI with no statistical significance between groups. The average length of hospital stay (days) was: underweight: 7.19 (p=0.06), normal: 2.63, overweight: 2.43 (p=0.75), obese: 2.57 (p=0.64), severely obese: 1.5 (p=2.64).
Conclusions: Increased BMI does not increase the operative time, need for blood transfusion, perioperative or intraoperative complication rates of carotid endarterectomy.
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