The impact of obesity on postoperative pulmonary complications in patients undergoing aortic surgery

<title>Abstract</title> <bold>Background</bold> 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. <bold>Methods</bold> 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. <bold>Results</bold> 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; <italic>P</italic> = 0.003]. <bold>Conclusions</bold> 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.