Influence of Body Mass Index and Age on Functional Outcomes in Patients With Subarachnoid Hemorrhage

Tawk, Rabih G.; Grewal, Sanjeet S.; Heckman, Michael G.; Navarro, Ramón; Ferguson, Jennifer L.; Starke, Emily L.; Rawal, Bhupendra; Hanel, Ricardó A.; Miller, David W.; Wharen, Robert E.; Freeman, William D.

doi:10.1227/neu.0000000000000588

Cited by 29 publications

(19 citation statements)

References 28 publications

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Section: Discussionmentioning

confidence: 95%

“…Supporting this theory, a few studies [3,8,34] have related obesity to more favorable outcomes, measured using the modified Rankin Scale (mRS), and milder overweight to lower complication rates as well. On the other hand, other studies have reported contradictory findings [33,37,44]. While a protective effect of obesity in SAH survival is still questionable, morbidly obese SAH patients in particular seem to have several disadvantages.…”

Section: Discussionmentioning

confidence: 96%

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Obesity paradox in subarachnoid hemorrhage: a systematic review

2019

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As the number of obese people is globally increasing, reports about the putative protective effect of obesity in life-threatening diseases, such as subarachnoid hemorrhage (SAH), are gaining more interest. This theory-the obesity paradox-is challenging to study, and the impact of obesity has remained unclear in survival of several critical illnesses, including SAH. Thus, we performed a systematic review to clarify the relation of obesity and SAH mortality. Our study protocol included systematic literature search in PubMed, Scopus, and Cochrane library databases, whereas risk-of-bias estimation and quality of each selected study were evaluated by the Critical Appraisal Skills Program and Cochrane Collaboration guidelines. A directional power analysis was performed to estimate sufficient sample size for significant results. From 176 reviewed studies, six fulfilled our eligibility criteria for qualitative analysis. One study found paradoxical effect (odds ratio, OR = 0.83 (0.74-0.92)) between morbid obesity (body mass index (BMI) > 40) and in-hospital SAH mortality, and another study found the effect between continuously increasing BMI and both short-term (OR = 0.90 (0.82-0.99)) and long-term SAH mortalities (OR = 0.92 (0.85-0.98)). However, according to our quality assessment, methodological shortcomings expose all reviewed studies to a high-risk-of-bias. Even though two studies suggest that obesity may protect SAH patients from death in the acute phase, all reviewed studies suffered from methodological shortcomings that have been typical in the research field of obesity paradox. Therefore, no definite conclusions could be drawn.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 96%

Obesity paradox in subarachnoid hemorrhage: a systematic review

2019

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“…The effect of BMI on outcomes after aSAH has been investigated previously, with conflicting results. 9,13,15,17,28,29,33,38 The inconsistent effect across multiple studies may be partially explained by differences in the frequency of treatment with clipping versus coiling. Five separate studies investigating this topic either provided information on treatment modality for study subjects 13,15,27,29 or performed subgroup analyses for patients treated with clipping versus coiling.…”

Section: Discussionmentioning

confidence: 99%

“…

P revious work has suggested the possibility of a protective effect of increased body mass index (BMI) on patients suffering from aneurysmal subarachnoid hemorrhage (aSAH). 13,38 This finding, however, has not been consistently observed in other studies; 9,17,28,29,33 in fact, certain studies have observed a negative effect of increased BMI on patient outcomes. 15,27 Ruptured aneurysms are typically secured with either surgical clipping or endovascular coiling.

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confidence: 86%

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Rinaldo¹,

Hughes²,

Rabinstein

et al. 2018

Journal of Neurosurgery

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OBJECTIVE It has been suggested that increased body mass index (BMI) may confer a protective effect on patients who suffer from aneurysmal subarachnoid hemorrhage (aSAH). Whether the modality of aneurysm occlusion influences the effect of BMI on patient outcomes is not well understood. The authors aimed to compare the effect of BMI on outcomes for patients with aSAH treated with surgical clipping versus endovascular coiling. METHODS The authors retrospectively reviewed the outcomes for patients admitted to their institution for the management of aSAH treated with either clipping or coiling. BMI at the time of admission was recorded and used to assign patients to a group according to low or high BMI. Cutoff values for BMI were determined by classification and regression tree analysis. Predictors of poor functional outcome (defined as modified Rankin Scale score > 2 measured ≥ 90 days after the ictus) and posttreatment cerebral hypodensities detected during admission were then determined separately for patients treated with clipping or coiling using stepwise multivariate logistic regression analysis. RESULTS Of the 469 patients admitted to the authors' institution with aSAH who met the study's inclusion criteria, 144 were treated with clipping and 325 were treated with coiling. In the clipping group, the frequency of poor functional outcome was higher in patients with BMI ≥ 32.3 kg/m (47.6% vs 19.0%; p = 0.007). In contrast, in the coiling group, patients with BMI ≥ 32.3 kg/m had a lower frequency of poor functional outcome at ≥ 90 days (5.8% vs 30.9%; p < 0.001). On multivariate analysis, high BMI was independently associated with an increased (OR 3.92, 95% CI 1.20-13.41; p = 0.024) and decreased (OR 0.13, 95% CI 0.03-0.40; p < 0.001) likelihood of poor functional outcome for patients treated with clipping and coiling, respectively. For patients in the surgical group, BMI ≥ 28.4 kg/m was independently associated with incidence of cerebral hypodensities during admission (OR 2.44, 95% CI 1.16-5.25; p = 0.018) on multivariate analysis. For patients treated with coiling, BMI ≥ 33.2 kg/m was independently associated with reduced odds of hypodensities (OR 0.45, 95% CI 0.21-0.89; p = 0.021). CONCLUSIONS The results of this study suggest that BMI may differentially affect functional outcomes after aSAH, depending on treatment modality. These findings may aid in treatment selection for patients with aSAH.

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“…15 Nonetheless, neither study found variations in outcomes by body habitus. 30,35 In this NSQIP analysis, 11,510 patients were analyzed to evaluate the impact of body habitus on outcomes. There were several notable differences in baseline characteristics-ASA score, hypertension, diabetes, and preoperative dyspnea all varied significantly by BMI.…”

Section: Discussionmentioning

confidence: 99%

Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Dasenbrock

Liu

Chavakula

et al. 2017

JNS

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OBJECTIVE Although there is a growing body of research highlighting the negative impact of obesity and malnutrition on surgical outcomes, few studies have evaluated these parameters in patients undergoing intracranial surgery. The goal of this study was to use a national registry to evaluate the association of body mass index (BMI) and hypoalbuminemia with 30-day outcomes after craniotomy for tumor. METHODS Adult patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry. Patients were stratified by body habitus according to the WHO classification, as well as by preoperative hypoalbuminemia (< 3.5 g/dl). Multivariable logistic regression evaluated the association of body habitus and hypoalbuminemia with 30-day mortality, complications, and discharge disposition. Covariates included patient age, sex, race or ethnicity, tumor histology, American Society of Anesthesiology class, preoperative functional status, comorbidities (including hypertension and diabetes mellitus), and additional preoperative laboratory values. RESULTS Among the 11,510 patients included, 28.7% were classified as normal weight (BMI 18.5-24.9 kg/m), 1.9% as underweight (BMI < 18.5 kg/m), 33.4% as overweight (BMI 25.0-29.9 kg/m), 19.1% as Class I obese (BMI 30.0-34.9 kg/m), 8.3% as Class II obese (BMI 35.0-39.9 kg/m), 5.5% as Class III obese (BMI ≥ 40.0 kg/m), and 3.1% had missing BMI data. In multivariable regression models, body habitus was not associated with differential odds of mortality, postoperative stroke or coma, or a nonroutine hospital discharge. However, the adjusted odds of a major complication were significantly higher for Class I obese (OR 1.28, 99% CI 1.01-1.62; p = 0.008), Class II obese (OR 1.53, 99% CI 1.13-2.07; p < 0.001), and Class III obese (OR 1.67, 99% CI 1.19-2.36; p < 0.001) patients compared with those of normal weight; a dose-dependent effect was seen, with increased effect size with greater adiposity. The higher odds of major complications was primarily due to significantly increased odds of a venous thromboembolism in overweight and obese patients, as well as of a surgical site infection in those with Class II or III obesity. Additionally, 41.0% of patients had an albumin level ≥ 3.5 g/dl, 9.6% had hypoalbuminemia, and 49.4% had a missing albumin value. Hypoalbuminemia was associated with significantly higher odds of mortality (OR 1.91, 95% CI 1.41-2.60; p < 0.001) or a nonroutine hospital discharge (OR 1.46, 95% CI 1.21-1.76; p < 0.001). CONCLUSIONS In this National Surgical Quality Improvement Program analysis evaluating patients who underwent craniotomy for tumor, body habitus was not associated with differential mortality or neurological complications. However, obese patients had increased odds of a major perioperative complication, primarily due to higher rates of venous thromboembolic events and surgical site infections. Preoperative hypoalbuminemia was associated with increased odds of mortality and a nonroutine hospital discharge, s...

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Influence of Body Mass Index and Age on Functional Outcomes in Patients With Subarachnoid Hemorrhage

Cited by 29 publications

References 28 publications

Obesity paradox in subarachnoid hemorrhage: a systematic review

Obesity paradox in subarachnoid hemorrhage: a systematic review

Effect of body mass index on outcome after aneurysmal subarachnoid hemorrhage treated with clipping versus coiling

Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

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