Impact of body mass index on perioperative mortality of acute stanford type A aortic dissection: a systematic review and meta-analysis

• Type of Material: Article
• Authors: Wenyu Song, Fudan University; Jiani Liu, The Chinese University of Hong Kong; Guowei Tu, Fudan University; Lulu Pan, Nanjing Medical University; Yixiang Hong, Emory University; Lieyang Qin, Fudan University; Lai Wei, Fudan University; Jinmiao Chen, Fudan University
• Language: English
• Date: 2023-10-31
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © 2023, The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1186/s12872-023-03517-z
• Title of Journal or Parent Work: BMC Cardiovascular Disorders
• Volume: 23
• Start Page: 531
• Grant/Funding Information: This work was sponsored by the National Natural Science Foundation of China (No.82200526 and No.81970328), the Shanghai Rising-Star Program (No.23QB1400900), the Shanghai “Rising Stars of Medical Talents” Youth Development Program (No.SHWRS2023-62), the Shanghai Sailing Program (No.20YF1405400), the Clinical Research Fund of Shanghai Municipal Health Commission (No.20224Y0286), and the Shanghai Special Research Project on Aging Population and Maternal and Child Health (No.2020YJZX010).
• Keywords: Meta-analysis; Acute Stanford type A aortic dissection; Perioperative mortality; Body mass index; Systematic review
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background Obesity may increase perioperative mortality of acute Stanford type A aortic dissection (ATAAD). However, the available evidence was limited. This study aimed to systematically review published literatures about body mass index (BMI) and perioperative mortality of ATAAD. Methods Electronic literature search was conducted in PubMed, Medline, Embase and Cochrane Library databases. All observational studies that investigated BMI and perioperative mortality of ATAAD were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Meta-regression analysis was performed to assess the effects of different clinical variables on BMI and perioperative mortality of ATAAD. Sensitivity analysis was performed to determine the sources of heterogeneity. Egger’s linear regression method and funnel plot were used to determine the publication bias. Results A total of 12 studies with 5,522 patients were eligible and included in this meta-analysis. Pooled analysis showed that perioperative mortality of ATAAD increased by 22% for each 1 kg/m2 increase in BMI (OR = 1.22, 95% CI: 1.10–1.35). Univariable meta-regression analysis indicated that age and female gender significantly modified the association between BMI and perioperative mortality of ATAAD in a positive manner (meta-regression on age: coefficient = 0.04, P = 0.04; meta-regression on female gender: coefficient = 0.02, P = 0.03). Neither significant heterogeneity nor publication bias were found among included studies. Conclusions BMI is closely associated with perioperative mortality of ATAAD. Optimal perioperative management needs to be further explored and individualized for obese patient with ATAAD, especially in elderly and female populations.