Body Habitus and Body Mass Index: How They Influence the Outcomes of Aneurysmal Subarachnoid Haemorrhage Treated by Microsurgical Aneurysm Repair

Abstract

ABSTRACT Objective: Although the prevalence of obesity is increasing rapidly, few studies have analysed outcomes among obese patients undergoing cranial neurosurgery. The goal of this study was to evaluate the association of obesity with treatment outcomes among patients with aneurysmal subarachnoid haemorrhage (aSAH) treated by microsurgical aneurysmal repair. Methodology: A prospective study was conducted for 1 year in aSAH patients managed by microsurgical clipping with a minimum follow-up of 6 months. The body habitus of patients was classified as non-obese (body mass index [BMI] <30 kg/m2), obese (BMI ≥30 kg/m2 and ≤40 kg/m2) or morbidly obese (BMI >40 kg/m2). Multivariable analysis was done to evaluate the association of body habitus with in-hospital mortality rate and complications. Covariates included patient demographics (age and sex), comorbidities (including hypertension and diabetes) and associated systemic diseases (including cardiac, respiratory and other parenchymal diseases). Results: In total, 106 patients were included in this prospective study over 1 year. Obese and morbidly obese patients had a greater number of comorbidities than non-obese patients (P < 0.001) and had poor grades of presentation of SAH. Mortality rates for obese (19.04%) and morbidly obese patients (20%) did not significantly differ from those for non-obese patients (17.36%); however, poor functional outcome was associated with mildly and morbidly obese patients. Morbid obesity was associated with significantly increased odds of several medical complications, including venous thromboembolic and pulmonary and cardiac complications and infections (attributable to greater odds of urinary tract and surgical site infections). Conclusions: Obesity in patients of aneurysmal SAH treated by microsurgical clipping is associated with more comorbidities and higher odds of post-operative complications resulting in poor functional outcomes, with no significant difference in mortality rates.