LAUSR

OBJECTIVES Prevalence of obesity in US is increasing. The impact of obesity on outcomes after endovascular and open abdominal aortic aneurysm (AAA) repair is largely unknown. The purpose of this analysis was to compare the postoperative outcomes between obese and non-obese patients after these operations. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from years 2013-2015 was analyzed. Pre-operative, intra-operative and postoperative variables was compared between obese and non-obese patient groups. Then obese and non-obese patients were divided into two groups each, based on the type of surgery (EVAR vs. open AAA repair) and the outcomes were compared. Then multivariant analysis was used to compare impact of operative modality on outcomes for obese and non-obese patients. RESULTS A total of 6,859 patients (Males 80%, Females 20%) underwent surgical procedures for AAA during this time period. Among these patients, 2,218 (32.3%) had BMI ≥30 and 4,641 (67.7%) had BMI <30. Obese patients were less likely to be >80 years old, females, non-whites, smokers. Obese patients had lower mortality and higher risk of deep wound infections after surgery (p<0.05). Among the obese patients, 83.1% underwent EVAR and 16.9% open AAA repair: patients undergoing EVAR had shorter operative times, shorter length of hospital stays, mortality (p<0.05). Among non-obese patients, 81% underwent EVAR and 19% open AAA repair. Patients undergoing EVAR had shorter duration of operation, length of hospital stay and mortality (p<0.05). Overall, mortality was the highest among non-obese patients undergoing open AAA repair (OR 0.66, CI0.44-0.99, p<0.05). Incidence of deep wound infections was the highest among obese patients undergoing open AAA repair (OR4.3, CI: 1.2-14.6, p<0.05). CONCLUSIONS Non-obese patients have high mortality after open AAA repair and obese patients have higher incidence of deep wound infections after open AAA repair. For patients deemed appropriate anatomic candidates, EVAR should be preferred for non-obese patients to improve mortality and for obese patients to reduce the incidence of deep wound infections.