nach oben

Obesity Surgery

Erschienen in:

02.07.2020 | Original Contributions

Bariatric Surgery and Hospitalization for Heart Failure in Morbidly Obese Patients

verfasst von: Gursukhmandeep Singh Sidhu, Rohan Samson, Karnika Ayinapudi, Thierry H. Le Jemtel

Erschienen in: Obesity Surgery | Ausgabe 11/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Bariatric surgery may improve heart failure outcome in morbidly obese patients. However, the safety of bariatric surgery has not been investigated in morbidly obese patients hospitalized for heart failure. We evaluated the effects of bariatric surgery on parameters of hospitalization for heart failure in morbidly obese patients.

Methods

We analyzed administrative discharge data of morbidly obese patients with heart failure as a primary diagnosis. Propensity score matching was performed to assess parameters of hospitalization in morbidly obese patients with and without a history of bariatric surgery. The discharges with diastolic heart failure codes were analyzed separately.

Results

Morbid obesity was coded in 4.4% of all discharges. Heart failure was the primary diagnosis in 6.0% of discharges with morbid obesity codes. Only 1% of discharges with morbid obesity and heart failure as primary diagnosis codes were coded for bariatric surgery. Length of stay (p < 0.001), in-hospital mortality (p < 0.001), and the estimated cost of hospitalizations (p < 0.007) were lower in discharges with than without bariatric surgery codes. Length of stay was shorter and in-hospital mortality was lower in discharges with codes for diastolic heart failure and bariatric surgery than with codes for only diastolic heart failure (p < 0.042 and p < 0.001 respectively).

Conclusion

When hospitalized for heart failure, morbidly obese patients who underwent bariatric surgery fare as well as or slightly better than their counterparts who did not.

Nur mit Berechtigung zugänglich

Lavie CJ, Alpert MA, Arena R, et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013;1:93–102.PubMed

Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.PubMed

Shah RV, Murthy VL, Abbasi SA, et al. Visceral adiposity and the risk of metabolic syndrome across body mass index. JACC Cardiovasc Imaging. 2014;7:1221–35.PubMedPubMedCentral

Horwich TB, Fonarow GC, Hamilton MA, et al. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol. 2001;38:789–95.PubMed

Alpert MA, Pritchett AM. Bariatric surgery in patients with left ventricular systolic dysfunction: effective, but is it safe? Circ Heart Fail. 2016;9:e002960.PubMed

Vest AR, Schauer PR, Young JB. Failure and fatness. J Am Coll Cardiol. 2016;67:904–6.PubMed

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128 https://doi.org/10.1161/CIR.0b013e31829e8776.

Vest AR, Patel P, Schauer PR, et al. Clinical and echocardiographic outcomes after bariatric surgery in obese patients with left ventricular systolic dysfunction. Circ Heart Fail. 2016;9:e002260.PubMed

Ramani GV, McCloskey C, Ramanathan RC, et al. Safety and efficacy of bariatric surgery in morbidly obese patients with severe systolic heart failure. Clin Cardiol. 2008;31:516–20.PubMedPubMedCentral

10.

Benotti PN, Wood GC, Carey DJ, et al. Gastric bypass surgery produces a durable reduction in cardiovascular disease risk factors and reduces the long-term risks of congestive heart failure. J Am Heart Assoc. 2017;6 https://doi.org/10.1161/JAHA.116.005126.

11.

Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51. https://doi.org/10.1056/NEJMoa1600869.CrossRefPubMedPubMedCentral

12.

Schiavon CA, Bersch-Ferreira AC, Santucci EV, et al. Effects of bariatric surgery in obese patients with hypertension the GATEWAY randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. 2018;137:1132–42. https://doi.org/10.1161/CIRCULATIONAHA.117.032130.CrossRefPubMed

13.

HCUP-US NIS overview. Available at https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed September 12, 2018.

14.

2012 HCUP National Inpatient Sample (NIS) comparison report. Available at https://www.hcup-us.ahrq.gov/db/nation/nis/reports/2012niscomparisonrpt.jsp. Accessed September 16, 2018.

15.

Healthcare Cost and Utilization Project (HCUP) NIS notes. Available at https://www.hcup-us.ahrq.gov/db/vars/dxn/nisnote.jsp. Accessed September 20, 2019.

16.

Birman-Deych E, Waterman AD, Yan Y, et al. Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors. Med Care. 2005;43:480–5.PubMed

17.

Njei B, McCarty TR, Sharma P, et al. Bariatric surgery and hepatocellular carcinoma: a propensity score-matched analysis. Obes Surg. 2018;28:3880–9. https://doi.org/10.1007/s11695-018-3431-5.CrossRefPubMedPubMedCentral

18.

McCarty TR, Echouffo-Tcheugui JB, Lange A, et al. Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004–2012. Surg Obes Relat Dis. 2018;14:74–80. https://doi.org/10.1016/j.soard.2017.09.511.CrossRefPubMed

19.

Prophet S. V codes: supplementary classification of factors influencing health status and contact with health services. J AHIMA. 1996;

20.

Ammann EM, Kalsekar I, Yoo A, et al. Assessment of obesity prevalence and validity of obesity diagnoses coded in claims data for selected surgical populations: a retrospective, observational study. Medicine (Baltimore). 2019;98:e16438. https://doi.org/10.1097/MD.0000000000016438.CrossRef

21.

CPI inflation calculator. Available at https://www.bls.gov/data/inflation_calculator.htm. Accessed November 25, 2018.

22.

HCUP methods series using the HCUP National Inpatient Sample to estimate trends (revised 12/15/15) Report # 2006-05. Available at http://www.hcup-us.ahrq.gov. Accessed September 12, 2018.

23.

Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.PubMed

24.

Thompson NR, Fan Y, Dalton JE, et al. A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality. Med Care. 2015;53:374–9.PubMedPubMedCentral

25.

Houchens RL, Ross DN, Elixhauser A and JJ. Nationwide inpatient sample redesign report. 2014.

26.

van Walraven C, Austin PC, Jennings A, et al. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47:626–33.PubMed

27.

DuGoff EH, Schuler M, Stuart EA. Generalizing observational study results: applying propensity score methods to complex surveys. Health Serv Res. 2014;49:284–303.PubMed

28.

Ho DE, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. 2011. Available at http://www.jstatsoft.org/. Accessed September 16, 2018.

29.

Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399–424.PubMedPubMedCentral

30.

Bello NA, Claggett B, Desai AS, et al. Influence of previous heart failure hospitalization on cardiovascular events in patients with reduced and preserved ejection fraction. Circ Heart Fail. 2014;7:590–5.PubMedPubMedCentral

31.

Ashrafian H, le Roux CW, Darzi A, et al. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091–102.PubMed

32.

Cuspidi C, Sala C, Tadic M, et al. Untreated masked hypertension and subclinical cardiac damage: a systematic review and meta-analysis. Am J Hypertens. 2015;28:806–13.PubMed

33.

Ippisch HM, Inge TH, Daniels SR, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008;51:1342–8.PubMed

34.

Brownell NK, Rodriguez-Flores M, Garcia-Garcia E, et al. Impact of body mass index >50 on cardiac structural and functional characteristics and surgical outcomes after bariatric surgery. Obes Surg. 2016;26:2772–8.PubMed

35.

Garza CA, Pellikka PA, Somers VK, et al. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010;105:550–6.PubMed

36.

Le Jemtel TH, Samson R, Milligan G, et al. Visceral adipose tissue accumulation and residual cardiovascular risk. Curr Hypertens Rep. 2018;20:77.PubMed

37.

Kishi S, Armstrong AC, Gidding SS, et al. Association of obesity in early adulthood and middle age with incipient left ventricular dysfunction and structural remodeling: the CARDIA study (Coronary Artery Risk Development in Young Adults). JACC Heart Fail. 2014;2:500–8.PubMedPubMedCentral

38.

Wong CY, O’Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004;110:3081–7.PubMed

39.

Selvaraj S, Martinez EE, Aguilar FG, et al. Association of Central Adiposity with Adverse Cardiac Mechanics: findings from the hypertension genetic epidemiology network study. Circ Cardiovasc Imaging. 2016;9 https://doi.org/10.1161/CIRCIMAGING.115.004396.

40.

Blomstrand P, Sjöblom P, Nilsson M, et al. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol. 2018;17:113.PubMedPubMedCentral

41.

Powell BD, Redfield MM, Bybee KA, et al. Association of obesity with left ventricular remodeling and diastolic dysfunction in patients without coronary artery disease. Am J Cardiol. 2006;98:116–20.PubMed

42.

Lavie CJ, Carbone S, Agarwal MA. An obesity paradox with myocardial infarction in the elderly. Nutrition. 2018;46:122–3.PubMed

43.

Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898–918.PubMed

44.

Owan T, Avelar E, Morley K, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study. J Am Coll Cardiol. 2011;57:732–9.PubMedPubMedCentral

45.

Ristow B, Ali S, Whooley MA, et al. Usefulness of left atrial volume index to predict heart failure hospitalization and mortality in ambulatory patients with coronary heart disease and comparison to left ventricular ejection fraction (from the Heart and Soul Study). Am J Cardiol. 2008;102:70–6.PubMedPubMedCentral

46.

Lim C-P, Fisher OM, Falkenback D, et al. Bariatric surgery provides a "bridge to transplant" for morbidly obese patients with advanced heart failure and may obviate the need for transplantation. Obes Surg. 2016;26:486–93.PubMed

47.

Samaras K, Connolly SM, Lord RV, et al. Take heart: bariatric surgery in obese patients with severe heart failure. Two case reports. Heart Lung Circ. 2012;21:847–9.PubMed

48.

Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.PubMed

49.

Shimada YJ, Tsugawa Y, Brown DFM, et al. Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series. J Am Coll Cardiol. 2016;67:895–903.PubMed

50.

Persson CE, Björck L, Lagergren J, et al. Risk of heart failure in obese patients with and without bariatric surgery in Sweden-a registry-based study. J Card Fail. 2017;23:530–7.PubMed

51.

Sundström J, Bruze G, Ottosson J, et al. Weight loss and heart failure: a nationwide study of gastric bypass surgery versus intensive lifestyle treatment. Circulation. 2017;135:1577–85.PubMedPubMedCentral

52.

Clark AL, Chyu J, Horwich TB. The obesity paradox in men versus women with systolic heart failure. Am J Cardiol. 2012;110:77–82.PubMedPubMedCentral

53.

Kenchaiah S, Pocock SJ, Wang D, et al. Body mass index and prognosis in patients with chronic heart failure. Circulation. 2007;116:627–36.PubMed

54.

Sharma A, Lavie CJ, Borer JS, et al. Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. Am J Cardiol. 2015;115:1428–34.PubMed

55.

Shah SJ. Matchmaking for the optimization of clinical trials of heart failure with preserved ejection fraction: no laughing matter. J Am Coll Cardiol. 2013;62:1339–42.PubMed

56.

Oga EA, Eseyin OR. The obesity paradox and heart failure: a systematic review of a decade of evidence. J Obes. 2016;2016:1–9.

57.

Nagarajan V, Cauthen CA, Starling RC, et al. Prognosis of morbid obesity patients with advanced heart failure. Congest Heart Fail. 2013;19:160–4.PubMed

58.

Joyce E, Chung C, Badloe S, et al. Variable contribution of heart failure to quality of life in ambulatory heart failure with reduced, better, or preserved ejection fraction. JACC Heart Fail. 2016;4:184–93.PubMed

59.

Chan DC, Heidenreich PA, Weinstein MC, et al. Heart failure disease management programs: a cost-effectiveness analysis. Am Heart J. 2008;155:332–8.PubMed

60.

Fonarow GC. Reply. Am Heart J. 2007;154:e21.PubMed

61.

Aune D, Sen A, Norat T, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: a systematic review and dose-response meta-analysis of prospective studies. Circulation. 2016;133:639–49.PubMed

62.

Ndumele CE, Matsushita K, Lazo M, et al. Obesity and subtypes of incident cardiovascular disease. J Am Heart Assoc. 2016;5 https://doi.org/10.1161/JAHA.116.003921.

63.

Bello NA, Cheng S, Claggett B, et al. Association of weight and body composition on cardiac structure and function in the ARIC Study (Atherosclerosis Risk in Communities). Circ Heart Fail. 2016;9:e002978.PubMedPubMedCentral

64.

Hirayama A, Goto T, Shimada YJ, et al. Association of obesity with severity of heart failure exacerbation: a population-based study. J Am Heart Assoc. 2018;7 https://doi.org/10.1161/JAHA.117.008243.

65.

Nguyen AT, Tsai C, Hwang L, et al. Obesity and mortality, length of stay and hospital cost among patients with sepsis: a nationwide inpatient retrospective cohort study. PLoS One. 2016;11:e0154599.PubMedPubMedCentral

66.

Hossain M, Amin A, Paul A, et al. Recognizing obesity in adult hospitalized patients: a retrospective cohort study assessing rates of documentation and prevalence of obesity. J Clin Med. 2018;7:203.PubMedCentral

Titel: Bariatric Surgery and Hospitalization for Heart Failure in Morbidly Obese Patients
verfasst von: Gursukhmandeep Singh Sidhu
Rohan Samson
Karnika Ayinapudi
Thierry H. Le Jemtel
Publikationsdatum: 02.07.2020
Verlag: Springer US
Erschienen in: Obesity Surgery / Ausgabe 11/2020
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04787-8

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2020

5-Year Results of Banded One-Anastomosis Gastric Bypass: a Pilot Study in Super-Obese Patients

Totally Laparoscopic Transgastric Resection of a Gastric Submucosal Fibrolipoma and Concomitant Sleeve Gastrectomy in a Morbidly Obese Patient

The “Hug” Technique—Roux-en-Y Gastric Bypass with Preservation of the Posterior Wrap in Patients with Previous Nissen Fundoplication: a Simple Solution for a Complex Problem

Swallow Magnetic Resonance Imaging Compared to 3D-Computed Tomography for Pouch Assessment and Hiatal Hernias After Roux-en-Y Gastric Bypass

Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients

Impact of Routine and Long-Term Follow-Up on Weight Loss after Bariatric Surgery

Update Chirurgie