Liang Tiffany W, Wang S Keisin, Dimusto Paul D, McAninch Christopher M, Acher Charles W, Timsina Lava R, Dalsing Michael C, Motaganahalli Raghu L
Division of Vascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Vascular Surgery, 5228University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Vasc Endovascular Surg. 2020 Oct;54(7):573-578. doi: 10.1177/1538574420939356. Epub 2020 Jul 9.
The attempt to repair a ruptured abdominal aortic aneurysm carries a significant risk of perioperative mortality. The relationship between body mass index (BMI) and outcomes after repair of ruptured abdominal aortic aneurysms (AAAs) has not been well defined. We report the association of BMI with outcomes after ruptured AAA repair.
Patients undergoing ruptured AAA repairs between 2008 and 2017 at 2 tertiary academic centers were included in this retrospective study. Demographics (including BMI), type of repair, length of stay, and admission mortality risk scores were gathered and analyzed using bivariate and multivariate logistic regressions. Adjusted odds ratio (AOR) was reported with 95% CIs and values from the multivariate analysis. The primary outcome was 30-day mortality. Akaike information criterion (AIC) and c-statistics were used to assess the predictive power of models including physiologic score with or without BMI.
A total of 202 patients underwent repair of ruptured AAA. In bivariate relationship, increased BMI was significantly associated with 30-day mortality. With multivariate analysis, adjusting for demographics, type of procedure, and physiologic score, for each kg/m increase in BMI, an 8% increase in the likelihood of perioperative mortality (AOR = 1.08, 95% CI: 1.01-1.17; = .04) was observed.
When adjusted for admission risk score, type of procedure, and demographics, obesity was associated with increased 30-day mortality. With BMI as an additional data point, the c-statistics and AIC comparisons indicated that we would have a greater ability to preoperatively estimate mortality after ruptured AAA repair. Consideration could be made to include BMI in future mortality risk scoring systems for ruptured AAA.
修复破裂的腹主动脉瘤手术具有较高的围手术期死亡风险。体重指数（BMI）与破裂腹主动脉瘤（AAA）修复术后的预后之间的关系尚未明确界定。我们报告了BMI与破裂AAA修复术后预后的相关性。
本回顾性研究纳入了2008年至2017年在2家三级学术中心接受破裂AAA修复手术的患者。收集人口统计学数据（包括BMI）、修复类型、住院时间和入院死亡风险评分，并使用双变量和多变量逻辑回归进行分析。报告多变量分析得出的调整优势比（AOR）及其95%置信区间和P值。主要结局为30天死亡率。使用赤池信息准则（AIC）和c统计量评估包含或不包含BMI的生理评分模型的预测能力。
共有202例患者接受了破裂AAA修复手术。在双变量关系中，BMI升高与30天死亡率显著相关。多变量分析显示，在调整了人口统计学、手术类型和生理评分后，BMI每增加1kg/m²，围手术期死亡可能性增加8%（AOR = 1.08，95%CI：1.01 - 1.17；P = 0.04）。
在调整入院风险评分、手术类型和人口统计学因素后，肥胖与30天死亡率增加相关。将BMI作为一个额外的数据点，c统计量和AIC比较表明，我们在术前估计破裂AAA修复术后死亡率方面将具有更强的能力。未来在破裂AAA的死亡率风险评分系统中可考虑纳入BMI。
