Wall Joshua John Sommerville, Boag Katie F, Waduud Mohammed A, Pabale Keleabetswe, Wood Benjamin, Bailey Marc, Scott Julian A
Leeds Vascular Institute, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom.
Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, West Yorkshire, United Kingdom.
Aorta (Stamford). 2022 Feb;10(1):20-25. doi: 10.1055/s-0042-1742699. Epub 2022 May 31.
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.
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.
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.
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.
The results of this study suggest patients should not be denied treatment for AAA based on obesity alone.
“肥胖悖论”指体重指数（BMI）与死亡率曲线呈“U”形，这是血管外科中一个经过充分研究的现象。然而，一直以来过度依赖BMI作为肥胖的衡量指标，而这一指标与临床结果的相关性较差。有人提出诸如腰臀比（WHR）等可靠指标作为反映中心性肥胖的更准确标志物。
本研究的目的是评估BMI与WHR在择期腹主动脉瘤（AAA）修复术后发病率和死亡率方面的相关性。
收集了2006年1月至2016年12月期间利兹血管研究所的数据。主要结局是死亡率，次要结局包括住院时间（LOS）和全因再入院率。采用二元逻辑回归、线性回归和相关性分析来确定BMI和WHR与结局指标之间的关联。
排除后，确定432例择期AAA修复术（281例开放手术修复[OSR]和151例血管内动脉瘤修复术[EVAR]）符合研究条件。30天和4年的综合死亡率分别为1.2%和20.1%。30天再入院率为3.9%，平均住院时间为7.33（标准差18.5）天。记录了275例患者（63.7%）的BMI数据和355例患者（82.2%）的WHR数据。逻辑回归分析表明，OSR或EVAR后BMI和WHR与死亡率、再入院率或住院时间之间无关联。
本研究结果表明，不应仅基于肥胖而拒绝为AAA患者提供治疗。
