title: Obesity is an independent risk factor for death and cardiac complications after carotid endarterectomy.
abstract: BACKGROUND
  The role of obesity as a risk factor after carotid endarterectomy is not well-described. We undertook a study of the association of obesity with 30-day outcomes after carotid endarterectomy.
  
  
  METHODS
  After obtaining Institutional Review Board approval, we retrospectively analyzed prospectively collected data from carotid endarterectomies in the 2005-2006 Veterans Affairs Surgical Quality Improvement Program database. The association of body mass index (BMI; calculated as kg/m(2)) on 30-day outcomes was assessed using multivariable logistic regression.
  
  
  RESULTS
  From 3,706 carotid endarterectomies, we excluded 22 for missing BMI and 39 for emergency status; 3,645 carotid endarterectomies were analyzed. BMI was underweight (<18.5) in 1.6%, normal (18.5 to 24.9) in 31.0%, overweight (25.0 to 29.9) in 40.8%, class I obese (30.0 to 34.9) in 19.3%, class II obese (35.0 to 39.9) in 5.8%, and class III obese (≥40) in 1.6%. On multivariable analysis, class II to III (odds ratio = 6.95; 95% CI, 1.89-25.58; p = 0.004) obesity was associated with death, and class II to III obesity was associated with cardiac complications (odds ratio = 3.68; 95% CI, 1.27-10.66; p = 0.02) compared with normal weight.
  
  
  CONCLUSIONS
  Obesity is an independent risk factor for death and cardiac complications after carotid endarterectomy. Surgeons should consider this when evaluating the risks and benefits of carotid endarterectomy in obese patients. Carotid artery stenting was not assessed, and future studies are needed to examine its role in management of obese patients.
authors.affiliation: Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC 20010, USA.
authors.forename: Rubie Sue
authors.initials: RS
authors.lastname: Jackson
authors.forename: Anton N
authors.initials: AN
authors.lastname: Sidawy
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Macsata
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D003327:Coronary Disease / Q000453:epidemiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome