Obesity and outcomes after elective thoracoabdominal aortic aneurysm repair

Objective

Obesity can complicate surgical repair, but its relationship to outcomes after open thoracoabdominal aortic aneurysm (TAAA) repair remains uncertain. Therefore, we examined whether obesity is associated with greater operative risk after elective TAAA repair.

Methods

We retrospectively evaluated data from 2517 open, elective, single-practice TAAA repairs (from 1986 to 2023) and compared patients without obesity or underweight (body mass index [BMI] 18.6-29.9; n = 1977) with patients with obesity (BMI ≥30; n = 540 [21.5%]). Multivariable logistic regression modeling identified predictors of operative mortality in patients with obesity. We created propensity-matched cohorts (n = 540 pairs) and compared their early and late outcomes, including late survival, by Kaplan-Meier analysis and log-rank testing.

Results

Compared with patients without obesity, patients with obesity were younger (median age, 64 years [Q1-Q3: 56-71] vs 68 [59-73] years; P < .001) and had greater rates of aortic dissection (45.7% vs 34.5%; P < .001) and diabetes (13.1% vs 6.9%; P < .001). Extent I repairs were more frequent in patients with obesity (30.6% vs 24.9%; P = .008). Operative mortality did not differ between groups (5.6% vs 6.6%; P = .9); however, persistent stroke was more frequent in patients with obesity (3.7% vs 2.0%, P = .02). Overall, BMI was not associated with operative mortality; within the patients with obesity, multivariable modeling found aortic dissection was independently associated with operative mortality. Propensity matching revealed no substantial differences in examined outcomes.

Conclusions

Patients with obesity undergoing TAAA repair differed from their counterparts without obesity regarding several factors. However, adjusted early outcomes after TAAA replacement did not differ by the presence or severity of obesity. We conclude that obesity alone should not deter surgeons from offering elective TAAA repair.