{
  "abstract": "Introduction/Purpose Obesity is a risk factor for cerebrovascular disease, yet its effect on neurointerventional outcomes is poorly understood. The ‘obesity paradox’ whereby higher BMI is associated with improved post-stroke survival has been described, but BMI alone fails to capture metabolic heterogeneity. We determined whether metabolic phenotype independently predicts in-hospital mortality, complications, and resource utilization after neurointerventional procedures.Materials and Methods We analyzed the National Inpatient Sample (2019–2022), identifying adults (≥18 years) undergoing mechanical thrombectomy, aneurysm coiling, flow diversion, carotid artery stenting, or intracranial stenting via ICD-10-PCS codes. Patients were classified into four metabolic phenotypes based on BMI (obese [ICD-10-CM E66.x] vs. non-obese) and metabolic health (≥2 of hypertension, diabetes mellitus, and hyperlipidemia = metabolically unhealthy), yielding: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). This 2×2 framework was described by Wildman et al. (Arch Intern Med 2008;168:1617–24) and validated in 3.5 million records by Caleyachetty et al. (JACC 2017;70:1429–37). The ≥2 of HTN/DM/HLD threshold has been applied in prior NIS stroke analyses (Mahadevan et al., J Neurol Sci 2025; Desai et al., Obes Pillars 2024). The primary outcome was in-hospital mortality. Secondary outcomes included nine complications and resource utilization. Complex samples logistic regression modeled mortality and complications; general linear models estimated adjusted resource utilization. Procedure-stratified mortality models were fitted for each procedure. All analyses incorporated NIS survey weights, strata, and clusters.Results We analyzed 69,656 unweighted discharges (348,280 weighted): MHNW (n=25,510), MUNW (n=33,071), MHO (n=3,299), MUO (n=7,776). MHNW patients were younger (63.1 years), predominantly female (54.0%), and underwent more flow diversions (28.5%) and coiling (14.7%); MUO patients were older (66.6 years) with more carotid stenting (33.9%). Crude mortality was highest in MHNW (8.6%) and lowest in MUO (5.1%; P<0.001). After adjustment (reference: MUO), MHNW had the highest mortality odds (aOR 1.79, 95% CI 1.59–2.02; P<0.001), followed by MHO (aOR 1.38, CI 1.15–1.66; P<0.001) and MUNW (aOR 1.25, CI 1.11–1.40; P<0.001). This persisted across procedure strata: thrombectomy (MHNW aOR 1.73, CI 1.51–1.97; P<0.001), coiling (aOR 2.29, CI 1.36–3.88; P=0.002), and carotid stenting (aOR 2.58, CI 1.76–3.77; P<0.001), but not flow diversion (Overall P=0.387). MHNW had higher adjusted odds of sepsis (aOR 2.00, CI 1.70–2.34; P<0.001), cardiac complications (aOR 1.54, CI 1.34–1.77; P<0.001), pneumonia (aOR 1.43, CI 1.30–1.57; P<0.001), VTE (aOR 1.39, CI 1.21–1.60; P<0.001), and respiratory failure (aOR 1.21, CI 1.12–1.30; P<0.001). MHNW had the longest adjusted length of stay (9.74 vs. 8.64 days; P<0.001) and highest charges ($265,790 vs. $240,895; P<0.001).Conclusion Metabolically healthy normal-weight patients not obese or metabolically unhealthy patients had the highest in-hospital mortality, complication burden, and resource utilization after neurointerventional procedures. The obesity paradox persists and is amplified by metabolic phenotyping: even after stratifying by metabolic health, obese patients had lower mortality than their lean counterparts. Confounding by indication likely contributes, as MHNW patients disproportionately undergo high-acuity emergency procedures. Metabolic phenotyping may improve perioperative risk stratification beyond BMI alone.Disclosures D. Vaishnav: None. T. Vadset: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "D Vaishnav"
    },
    {
      "affiliations": [
        "Neurological Surgery, Montefiore Medical Center, The Bronx, NY"
      ],
      "name": "AP Terraciano"
    },
    {
      "affiliations": [
        "Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "T Vadset"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Altschul"
    }
  ],
  "title": "E-309 Metabolic phenotype and in-hospital outcomes after neurointerventional procedures: a nationwide analysis",
  "uid": "ecbeb4ff-2674-58f3-aad2-07da265053ec"
}