Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC 20010, USA.
J Am Coll Surg. 2012 Feb;214(2):148-55. doi: 10.1016/j.jamcollsurg.2011.10.017. Epub 2011 Dec 21.
The role of obesity as a risk factor after carotid endarterectomy is not well-described. We undertook a study of the association of obesity with 30-day outcomes after carotid endarterectomy.
After obtaining Institutional Review Board approval, we retrospectively analyzed prospectively collected data from carotid endarterectomies in the 2005-2006 Veterans Affairs Surgical Quality Improvement Program database. The association of body mass index (BMI; calculated as kg/m(2)) on 30-day outcomes was assessed using multivariable logistic regression.
From 3,706 carotid endarterectomies, we excluded 22 for missing BMI and 39 for emergency status; 3,645 carotid endarterectomies were analyzed. BMI was underweight (<18.5) in 1.6%, normal (18.5 to 24.9) in 31.0%, overweight (25.0 to 29.9) in 40.8%, class I obese (30.0 to 34.9) in 19.3%, class II obese (35.0 to 39.9) in 5.8%, and class III obese (≥40) in 1.6%. On multivariable analysis, class II to III (odds ratio = 6.95; 95% CI, 1.89-25.58; p = 0.004) obesity was associated with death, and class II to III obesity was associated with cardiac complications (odds ratio = 3.68; 95% CI, 1.27-10.66; p = 0.02) compared with normal weight.
Obesity is an independent risk factor for death and cardiac complications after carotid endarterectomy. Surgeons should consider this when evaluating the risks and benefits of carotid endarterectomy in obese patients. Carotid artery stenting was not assessed, and future studies are needed to examine its role in management of obese patients.
肥胖作为颈动脉内膜切除术（CEA）后风险因素的作用尚未得到充分描述。我们进行了一项研究，以探讨肥胖与 CEA 后 30 天结局的关系。
在获得机构审查委员会批准后，我们回顾性地分析了 2005-2006 年退伍军人事务部手术质量改进计划数据库中颈动脉内膜切除术的前瞻性收集数据。使用多变量逻辑回归评估体重指数（BMI；kg/m2 计算）与 30 天结局的关系。
在 3706 例颈动脉内膜切除术中，我们排除了 22 例因 BMI 缺失和 39 例因紧急状态而未纳入分析；共分析了 3645 例颈动脉内膜切除术。BMI 为体重不足（<18.5）占 1.6%，正常（18.5 至 24.9）占 31.0%，超重（25.0 至 29.9）占 40.8%，I 级肥胖（30.0 至 34.9）占 19.3%，II 级肥胖（35.0 至 39.9）占 5.8%，III 级肥胖（≥40）占 1.6%。多变量分析显示，II 级至 III 级肥胖（比值比=6.95；95%可信区间，1.89-25.58；p=0.004）与死亡相关，II 级至 III 级肥胖与心脏并发症相关（比值比=3.68；95%可信区间，1.27-10.66；p=0.02），与正常体重相比。
肥胖是 CEA 后死亡和心脏并发症的独立危险因素。外科医生在评估肥胖患者 CEA 的风险和获益时应考虑到这一点。未评估颈动脉支架置入术，需要进一步研究以检查其在肥胖患者管理中的作用。
