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    The relationship between obesity and amputation-free survival in patients undergoing lower-limb revascularisation for chronic limb-threatening ischaemia: a retrospective cohort study

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    Author
    Sabbagh, Cezar
    Nickinson, Andrew
    Cullen, Sarah
    Patel, Bhavisha
    Dubkova, Svetlana
    Davies, Robert
    Sayers, Rob
    Keyword
    amputation
    body mass index
    obesity
    peripheral arterial disease
    vascular surgical procedures
    Date
    2022
    
    Metadata
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    Publisher's URL
    https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00564-1/fulltext
    Abstract
    Background: The obesity paradox is a well-documented phenomenon in cardiovascular disease, however it remains poorly understood. We aimed to investigate the relationship between body mass (as measured by body mass index [BMI]) and 1-year amputation-free survival (AFS) for patients undergoing lower limb revascularisation for chronic limb-threatening ischaemia (CLTI). Methods: A retrospective analysis was undertaken of all consecutive patients undergoing lower limb revascularisation for CLTI at the Leicester Vascular Institute between February 2018-19. Baseline demographics and outcomes were collected using electronic records. BMI was stratified using the World Health Organization criteria. One-year AFS (composite of major amputation/death) was the primary outcome. Kaplan-Meier survival analysis and adjusted Cox's proportional hazard models were used to compare groups to patients of normal mass. Results: One-hundred and ninety patients were included. Overall, no difference was identified in 1-year AFS across all groups (pooled P = 0.335). Compared to patients with normal BMI (n = 66), obese patients (n = 43) had a significantly lower adjusted combined risk of amputation/death (aHR 0.39, 95% CI 0.16-0.92, P = 0.032), however no significant differences were observed for overweight (aHR 0.89, 95% CI 0.47-1.70, P = 0.741), morbidly obese (aHR 1.15, 95% CI 0.41-3.20, P = 0.797) and underweight individuals (aHR 1.86, 95% CI 0.56-6.20, P = 0.314). Conclusions: In the context of CLTI, obesity is potentially associated with favourable amputation-free survival at 1 year, compared to normal body mass. The results of this study support the notion of an obesity paradox existing within CLTI and question whether current guidance on weight management requires a more patient-specific approach.
    Citation
    Sabbagh, C., Nickinson, A., Cullen, S., Patel, B., Dubkova, S., Gray, L., Davies, R., & Sayers, R. (2022). The Relationship Between Obesity and Amputation-free Survival in Patients Undergoing Lower-limb Revascularisation for Chronic Limb-threatening Ischaemia: A Retrospective Cohort Study. Annals of vascular surgery, 78, 288–294. https://doi.org/10.1016/j.avsg.2021.06.022
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15226
    Collections
    Vascular Services

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