Lower extremity arterial revascularization in obese patients.
BACKGROUND
Obesity and associated comorbidities are associated with a high rate of complications and technical difficulties after a number of surgical procedures. We studied the role of obesity in outcomes in lower extremity arterial revascularization.


METHODS
We reviewed all lower extremity arterial revascularizations performed at our institution in 2000. Body mass index (BMI) greater than or equal to 30 kg/m(2) defined obesity. Perioperative outcomes, long-term survival, and graft patency were evaluated in obese and nonobese patients by using linear regression, the Fisher exact test, and Kaplan-Meier analysis.


RESULTS
The study population consisted of 74 (26%) obese and 207 (74%) nonobese patients. Patient demographics of the obese and nonobese populations were similar. The mean BMI for obese patients was 35 +/- 5 kg/m(2) and in nonobese patients was 25 +/- 3 kg/m(2). The mean age of each group was 67 +/- 10 years (BMI > or =30 kg/m(2)) and 70 +/- 13 years (BMI <30 kg/m(2)). There were 45 (61%) obese men and 29 (39%) obese women. There were 128 (62%) nonobese men and 79 (38%) nonobese women. Diabetes was present in 76% of the obese and 70% of the nonobese patients. Perioperative myocardial infarction, 30-day mortality, and rate of reoperation within 30 days were not significantly different. Obese patients had higher increased postoperative wound infection rates (16% vs 7%; P = .04). Survival analysis showed 81% +/- 5% and 85% +/- 3% 1-year survival and 66% +/- 6% and 62% +/- 3% 3-year survival in obese and nonobese patients (P = .58), respectively. Kaplan-Meier estimates showed no effect of obesity on long-term graft patency, with 1-year graft patency rates of 82% +/- 6% and 81% +/- 4% in obese and nonobese patients, respectively (P = .79).


CONCLUSIONS
Obese patients have similar limb salvage rates, perioperative cardiac morbidity, long-term survival rates, and long-term graft patency but have increased perioperative wound infections.
Patel
Virendra I
VI
Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02114, USA. vpatel4@partners.org
Hamdan
Allen D
AD
Schermerhorn
Marc L
ML
Hile
Chantel
C
Dahlberg
Suzanne
S
Campbell
David R
DR
LoGerfo
Frank W
FW
Pomposelli
Frank B
FB
D000368:Aged; D015992:Body Mass Index; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D009765:Obesity / Q000150:complications*; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D016019:Survival Analysis; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects*