Obesity is not a risk factor for open aortic aneurysm repair using retroperitoneal approach and ERAS protocol

Obesity is a worldwide complex disease related to an increased risk of adverse outcomes in surgical patients, especially in abdominal aortic surgery. With the retroperitoneal approach, the abdominal fat falls to the right and the peritoneum opening is avoided, reducing invasiveness, and avoiding many technical challenges related to hostile abdomens. Furthermore, the combination of the Early Recovery After Surgery protocol is known to improve the outcome of abdominal surgery. especially in high-risk patients such as the obese population.

We conducted a single-center retrospective cohort study enrolling all consecutive patients undergoing elective open retroperitoneal aneurysm repair associated with the Early Recovery After Surgery protocol between January 2016 and December 2022. In the study cohort 53 obese (body mass index ≥30) (group 1) and 148 normal-weight patients (group 2) were identified. Primary end points were postoperative complications, need for intensive care admission, and length of hospital stay. Secondary end points were the perioperative mortality, overall survival and reinterventions rates at 1 year.

No significant differences (group 1, 58.5% vs group 2, 56.8%; P = .889) were found between the two groups for the overall postoperative complications rates. The results were confirmed also stratifying the Clavien-Dindo classification for minor (group 1, 50.9% vs group 2, 49.3%; P = .907) or major (group 1, 7.5% vs group 2, 7.4%; P = .979) complications rates. Postoperative intensive care unit admissions were significantly lower for group 1 compared with group 2 (50.9% vs 30.4%; P < .05). Instead, the length of hospital stay did not show differences between the two groups (5 days [interquartile range (IQR), 4.5-7.5 days] vs 5 days [IQR, 4-7 days]; P = .794). The mean follow-up period was 11.5 months (IQR, 2-31 months) for group 1 and 13 months (IQR, 1-30 months) for group 2 (P = .966). No significant differences emerged regarding mortality both at 30 days (group 1, 98.6% vs group 2, 100%; P = .395) and at 1 year (group 1, 94.3% vs group 2, 96.1%; P = .623). Finally, no reinterventions, not even on the abdominal wall, were necessary in the two groups during the study period.

Obesity, by itself, should not influence negatively the therapeutic choice if a proper surgical strategy is adopted.