The Impact of Obesity on Postoperative Pulmonary Complications in Patients Undergoing Aortic Surgery

Background Postoperative pulmonary complications (PPCs) are common following total aortic arch replacement with frozen elephant trunk (TAR + FET) in patients with acute type A aortic dissection (ATAAD). This study aimed to evaluate the incidence and risk factors for PPCs in ATAAD patients undergoing TAR + FET. Methods This single-center retrospective study included 203 patients with ATAAD who underwent TAR + FET between January 2023 and August 2024. Patients were divided into PPC and non-PPC groups. The incidence and types of PPCs were recorded, and risk factors were analyzed using multivariate logistic regression. Postoperative outcomes were compared between groups. Results The incidence of PPCs was 17.7%, with respiratory infections being the most common (9.9%), followed by respiratory failure (3.9%), acute respiratory distress syndrome (2.0%), pleural effusion (1.0%), pneumothorax (0.5%), and pulmonary embolism (0.5%). Multivariate analysis identified body mass index (BMI) as an independent risk factor for PPCs [odds ratio (OR): 1.144; 95% confidence interval (CI): 1.048–1.250; P  = 0.003]. Conclusions Higher BMI is independently associated with an increased risk of PPCs following TAR + FET in ATAAD patients. These findings highlight the importance of preoperative BMI assessment in optimizing perioperative management.