肥胖对胸主动脉腔内修复术结局的影响：系统评价和荟萃分析。
The effect of obesity on the outcome of thoracic endovascular aortic repair: a systematic review and meta-analysis.
机构信息
Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Institute of Gerontology, Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
PeerJ. 2024 Apr 19;12:e17246. doi: 10.7717/peerj.17246. eCollection 2024.
BACKGROUND
Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between obesity and outcomes of thoracic endovascular aortic repair (TEVAR) is still unclear. This systematic review and meta-analysis was performed to assess the roles of obesity in the outcomes of TEVAR.
METHODS
We systematically searched the Web of Science and PubMed databases to obtain articles regarding obesity and TEVAR that were published before July 2023. The odds ratio (OR) or hazard ratio (HR) was used to assess the effect of obesity on TEVAR outcomes. Body mass index (BMI) was also compared between patients experiencing adverse events after TEVAR and those not experiencing adverse events. The Newcastle-Ottawa Scale was used to evaluate the quality of the enrolled studies.
RESULTS
A total of 7,849 patients from 10 studies were included. All enrolled studies were high-quality. Overall, the risk of overall mortality (OR = 1.49, 95% CI [1.02-2.17], = 0.04) was increased in obese patients receiving TEVAR. However, the associations between obesity and overall complications (OR = 2.41, 95% CI [0.84-6.93], = 0.10) and specific complications were all insignificant, including stroke (OR = 1.39, 95% CI [0.56-3.45], = 0.48), spinal ischemia (OR = 0.97, 95% CI [0.64-1.47], = 0.89), neurological complications (OR = 0.13, 95% CI [0.01-2.37], = 0.17), endoleaks (OR = 1.02, 95% CI [0.46-2.29], = 0.96), wound complications (OR = 0.91, 95% CI [0.28-2.96], = 0.88), and renal failure (OR = 2.98, 95% CI [0.92-9.69], = 0.07). In addition, the patients who suffered from postoperative overall complications ( < 0.001) and acute kidney injury ( = 0.006) were found to have a higher BMI. In conclusion, obesity is closely associated with higher risk of mortality after TEVAR. However, TEVAR may still be suitable for obese patients. Physicians should pay more attention to the perioperative management of obese patients.
背景
肥胖是血管外科学后结局不良的已知预测因素。然而，肥胖与胸主动脉腔内修复术（TEVAR）结局的关系仍不清楚。本系统评价和荟萃分析旨在评估肥胖在 TEVAR 结局中的作用。
方法
我们系统地检索了 Web of Science 和 PubMed 数据库，以获取截至 2023 年 7 月发表的关于肥胖和 TEVAR 的文章。使用比值比（OR）或风险比（HR）来评估肥胖对 TEVAR 结局的影响。TEVAR 后发生不良事件的患者与未发生不良事件的患者的体重指数（BMI）也进行了比较。采用纽卡斯尔-渥太华量表评估纳入研究的质量。
结果
共纳入 10 项研究的 7849 例患者。所有纳入的研究均为高质量研究。总体而言，接受 TEVAR 的肥胖患者的全因死亡率（OR = 1.49，95%CI [1.02-2.17]， = 0.04）风险增加。然而，肥胖与总体并发症（OR = 2.41，95%CI [0.84-6.93]， = 0.10）和特定并发症之间的关联均无统计学意义，包括卒中（OR = 1.39，95%CI [0.56-3.45]， = 0.48）、脊髓缺血（OR = 0.97，95%CI [0.64-1.47]， = 0.89）、神经并发症（OR = 0.13，95%CI [0.01-2.37]， = 0.17）、内漏（OR = 1.02，95%CI [0.46-2.29]， = 0.96）、伤口并发症（OR = 0.91，95%CI [0.28-2.96]， = 0.88）和肾功能衰竭（OR = 2.98，95%CI [0.92-9.69]， = 0.07）。此外，术后发生总体并发症（ < 0.001）和急性肾损伤（ = 0.006）的患者 BMI 更高。总之，肥胖与 TEVAR 后死亡率升高密切相关。然而，TEVAR 可能仍适用于肥胖患者。医生应更加关注肥胖患者的围手术期管理。
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