Outcome After Operation for Aortic Dissection Type A in Morbidly Obese Patients

Abstract

Background: The number of obese patients is increasing, and more obese patients are likely to present for surgical repair of aortic dissection type A (ADA). We evaluated the effect of this procedure on the postoperative outcome of patients based on their body mass index (BMI; calculated as kg/m²).

Methods: A total of 667 patients who underwent surgical repair of ADA between 2003 and 2017 were retrospectively analyzed. Patients were divided into four groups according to BMI: normal weight (BMI: 18 to <25, n = 186), overweight (BMI: 25 to <30, n = 238), obese (BMI: 30 to <35, n = 144), and morbidly obese (BMI ≥35, n = 99). We compared clinical features and outcomes.

Results: No statistical difference was found regarding clinical presentation or proximal or distal aortic repair. Postoperative complications were similar among all groups. Although the rate for reintubation, tracheotomy, and the length of stay in the intensive care unit tended to be similar, the time to extubation (p = 0.010) and the total length of hospital stay (p = 0.017) were significantly longer in morbidly obese patients. Significantly more blood was transfused and replaced in the normal weight patients compared with the obese patients: in median 69% of the calculated blood volume was replaced in the normal weight patients compared with 32% in the morbidly obese patients (p < 0.001). In-hospital mortality and late survival were similar among all weight groups.

Conclusions: Despite the comorbidities that are associated with obesity, obese patients undergoing surgical repair of ADA are not at greater risk of death or other adverse outcomes. An immediate surgical approach should be considered in all patients independent of weight.