Background
Obesity is a known risk factor for the development and progression of chronic venous disorders (CVD). It is currently unknown if treatment outcomes, after an intervention for CVD, are affected by obesity. The purpose of this investigation was to assess the effectiveness of various CVD treatments in obese patients and determine what level of obesity is associated with poor outcomes.
Methods
Data was prospectively collected in the Center for Vein Restoration’s electronic medical record system (NexGen Healthcare Information System, Irvine, California), and retrospectively analyzed. Patients and limbs were categorized by the following BMI categories: < 25, 26–30, 31–35, 36–40, 41–45, > 46. Percent change in the revised venous clinical severity score (rVCSS) and the CIVIQ 20 quality of life survey, were utilized to determine CVD treatment effectiveness in patients who underwent endovenous thermal ablations (TA), phlebectomy, and ultrasound guided foam sclerotherapy (USGFS).
Results
From January 2015 to December 2017, 65,329 patients (77% female, 23% male) had a venous procedure performed. Of these patients, 25,592 (39,919 limbs) had an ablation alone, an ablation with a phlebectomy or an ablation with a phlebectomy and ultrasound guided foam sclerotherapy procedure. The number of procedures performed were as follows: TAs (37,781), USGFS (22,964) and phlebectomy (17,467). The degree of improvement six months post-procedure progressively decreased with increasing BMI in patients who underwent ablation alone; and, decreased more significantly in patients with BMI’s greater than 35 (p ≤ 0.001). Outcomes improved approximately 12% with the addition of phlebectomy to ablation. Patients who had ablations, phlebectomies and USGFS demonstrated no additional improvement. Significantly inferior outcomes were noted in patients with BMI’s ≥ 35, with the poorest outcomes observed in patients with a BMI ≥ 46 (p ≤ 0.001). The average number of ablations per patient, increased with increasing BMI and was significantly different compared to BMIs less that 30 (p ≤ 0.001). All pre and post CIVIQ 20 quality of life scores, within a BMI category, at six months were significantly different (p ≤ 0.01). No difference in the degree of improvement were observed in patients with a BMI ≥ 31. Finally, a multivariate logistic regression analysis indicated that when controlling for BMI, diabetes, a history of cancer, female gender and black and Hispanic race were independently associated with poorer outcomes.
Conclusions
Progressive increases in BMI negatively impact CVD related treatment outcomes as measured by rVCSS and CIVIQ 20. Outcomes progressively worsen with BMI’s greater than 35 for patients undergoing CVD treatments. Treatment outcomes in patients with a BMI ≥ 46 are so poor that weight loss management should be considered before offering CVD treatments.
