Early cardiac complications after bariatric surgery: does the type of procedure matter?

doi:10.1016/j.soard.2019.03.030

Surgery for Obesity and Related Diseases

Volume 15, Issue 7, July 2019, Pages 1132-1137

https://doi.org/10.1016/j.soard.2019.03.030 Get rights and content

Highlights

•
Postoperative major adverse cardiac events (MACE) occur in 0.1% bariatric surgeries.
•
Bariatric Surgery with MACE or dysrhythmia has higher mortality rates, up to 0.8%.
•
Age, gender, and comorbidities can predict MACE after bariatric surgery.
•
Compared to sleeve gastrectomy, gastric bypass does not increase the risk of MACE.

Abstract

Background

Major adverse cardiac events (MACE) can be a cause of postoperative mortality. This is specifically important in bariatric surgery due to obesity-related cardiovascular risk factors.

Objective

To assess postoperative cardiac adverse events after bariatric surgery and its independent predictors.

Setting

A retrospective analysis of 2011–2015 Healthcare Cost and Utilization Project-National Inpatient Sample.

Methods

Data on patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were retrieved. MACE was identified as a composite variable including myocardial infarction, acute ischemic heart disease without myocardial infarction, and acute heart failure. Dysrhythmia (excluding premature beats) was identified as a separate outcome. Multivariate regression analysis for MACE was performed using demographic factors, co-morbidities, and type of surgery.

Results

The analysis included 108,432 patients (SG: 54.6%, RYGB: 45.4%). MACE was found in 116 patients (.1%), and dysrhythmia occurred in 3670 patients (3.4%). Median length of stay in patients with MACE was 4.5 versus 2 days in others (P < .001). There were 43 deaths overall, and 31 were in patients with MACE or dysrhythmia (P < .001). Age ≥ 50 years, male sex, congestive heart failure, chronic pulmonary disease, ischemic heart disease, history of pulmonary emboli, and fluid or electrolyte disorders were independent predictors of MACE based on multivariate analysis. Type of surgery (SG versus RYGB) was not an independent predictor for MACE (odds ratio 1.41, 95% confidence interval: .77–2.55).

Conclusions

While cardiac complications are rare after bariatric surgery, their occurrence is associated with increased length of stay, hospital charges, and mortality. Older age, male sex, cardiopulmonary co-morbidities, and fluid or electrolyte disorders are predictive of MACE. RYGB does not increase the risk of MACE compared with SG.

Section snippets

Methods

This is a retrospective analysis of the Healthcare Cost and Utilization Project - National (Nationwide) Inpatient Sample (HCUP-NIS) from January 2011 to September 2015. HCUP-NIS is sponsored by the Agency of Healthcare Research and Quality (AHRQ). The National Inpatient Sample (NIS) database is a publicly available, administrative database that collects data from more than 7 million hospital admissions annually and is one of the largest longitudinal hospital care databases in the United States.

Results

A total of 108,432 patients were included. Mean age was 44.7 ± 12 years (range: 18–90), and 78.2% were female. Type of surgery was SG in 59,256 (54.6%) and RYGB in 49,176 (45.4%). MACE occurred in 116 patients (.1%), and dysrhythmia in 3670 patients (3.4%). The most common specified dysrhythmia was atrial fibrillation in 1959 (1.8%), atrial flutter in 130 (.1%), paroxysmal ventricular tachycardia in 121 (.1%), and paroxysmal supraventricular tachycardia in 83 patients (.1%). Table 1 shows the

Discussion

Obesity continues to rise globally, and its prevalence in 2015 to 2016 was nearly 40% among all U.S. adults [12]. Obesity has a direct relationship with mortality and is a public health concern due to its associated medical costs [13], [14]. Bariatric surgery is the most durable management option to achieve significant and sustained long-term weight loss [15], [16]. Weight loss is associated with the reversal of many obesity-related co-morbidities for many of these patients [17], [18]. This has

Conclusion

While cardiac complications are rare after bariatric surgery, their occurrence is associated with increased LOS, hospital charges, and mortality. Older age, male sex, cardiopulmonary co-morbidities, and fluid or electrolyte disorders are predictive of MACE. RYGB does not increase the risk of MACE compared with SG.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Impact of Bariatric Surgery on the Prevalence and Outcomes of Atrial Fibrillation in Obese Patients
2024, Current Problems in Cardiology
Obesity has been identified as a significant factor contributing to the development of numerous cardiovascular conditions and as a result, the cardiovascular community has prioritized efforts to address obesity and reduce its associated risks. However, despite these efforts, the prevalence of obesity continues to rise steadily, and is projected to double in the upcoming years. Atrial fibrillation is among the most prevalent and extensively researched cardiovascular comorbidities associated with obesity. Several mechanisms have been postulated, including scar tissue formation and fat deposition, which ultimately leads to atrial remodeling and subsequent arrhythmogenesis. Numerous strategies have been implemented to prevent and manage obesity, encompassing lifestyle adjustments, dietary modifications, pharmacological treatments, and surgical interventions. Bariatric surgery has garnered significant recognition over the years due to its promising outcomes, including a decrease in the overall prevalence of atrial fibrillation and other cardiovascular comorbidities in general in obese patients. This study focuses on the current trends regarding the impact of bariatric surgery on obese patients with atrial fibrillation.
Short-term cardiovascular events after bariatric surgery in patients with metabolic syndrome
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Patients with metabolic syndrome (MetS) are at increased risk of developing cardiovascular disease along with other adverse events after bariatric surgery.
The incidence of short-term major adverse cardiovascular events (MACE) in patients with MetS undergoing bariatric surgery is not well characterized.
Accredited bariatric surgery centers in the United States and Canada.
A total of 760,076 patients aged ≥18 years with body mass index ≥35 kg/m² who underwent primary bariatric surgery between 2015 and 2018 were included. Patients with both diabetes and hypertension were described as the MetS cohort. Patient characteristics, operative technique, and 30-day outcomes were compared. The primary outcome was incidence of MACE, a composite of myocardial infarction, stroke, and all-cause mortality. Unadjusted and multivariable logistic regression analyses were performed and included an interaction between MetS and hyperlipidemia (HLD).
Of the 577,882 patients included, 111,128 (19.2%) exhibited MetS. Patients with MetS more frequently experienced MACE compared with patients without MetS (.3% versus .1%; P < .001). The odds of MACE were greater for patients with MetS versus Non-MetS (odds ratio [OR] 2.87; 95% CI, 2.49–3.32) in the unadjusted analysis. MetS without HLD, MetS with HLD, and Non-MetS with HLD are significantly associated with MACE when compared with those with non-MetS without HLD.
Patients with MetS have an increased frequency of cardiac events following bariatric surgery. Future studies should determine if optimization of 1 or more components of MetS or other related co-morbidities reduces the cardiovascular risk for patients.
Safety of bariatric surgery in the elderly: results from the Dutch National Registry
2023, Surgery for Obesity and Related Diseases
The increased human life expectancy and prevalence of obesity lead to more elderly people with obesity. As the popularity of bariatric surgery continues to grow, more elderly persons apply for bariatric surgery. However, because of the potentially higher surgical risk in elderly patients, bariatric surgery has been performed in small numbers. Moreover, the literature so far has shown controversial results.
To determine the safety of bariatric surgery in elderly patients in terms of 2-year morbidity and mortality.
Dutch nationwide mandatory registry for bariatric surgery.
A population-based retrospective cohort study. Elderly patients (aged ≥65 years) who received primary bariatric surgery between January 2015 and January 2020 were compared with the general bariatric surgical population (aged 18–65 years).
Of 49,553 patients, 838 elderly patients (1.7%) were included. An intraoperative complication was registered in 1.2% of the elderly patients and 1.1% of the nonelderly patients (P = .814). A severe short-term complication (≤30 days) was registered in 38 elderly patients (4.5%) and 1071 nonelderly patients (2.2%) (P < .001). The short-term mortality rates were .2% and .1%, respectively (P = .173). Bleeding was the most reported short-term complication. Significantly more nonelderly patients had a follow-up visit; 560 elderly patients (66.8%) versus 34,975 nonelderly patients (71.8%) (P = .002). The severe midterm complication rate (>30 days to ≤2 years) was significantly higher in nonelderly patients (3.7% versus 1.6%; P = .008).
Bariatric surgery in elderly patients is safe in terms of perioperative outcome, mortality, and midterm complication rate. However, elderly patients experienced twice as many severe short-term complications. Bariatric surgery in elderly patients should be recommended on a case-by-case basis.
Effect of high-risk factors on postoperative major adverse cardiovascular and cerebrovascular events trends following bariatric surgery in the United States from 2012 to 2019
2023, Surgery for Obesity and Related Diseases
Citation Excerpt :
Despite these differences, however, both studies observed MACE incidence of ∼0.1% for LRYGB and LSG. These results are consistent with prior MACE incidence examining both index admission MACE and MACE within 30 days of BaS [15–17], suggesting that most MACE occur within the first week after BaS. Our results are consistent with previous studies showing older age, male sex, CAD, CKD, and CHF are independent predictors of MACE based on multivariate analysis [15,16].
Recent examination of trends in postoperative major adverse cardiovascular and cerebrovascular events (MACE) following bariatric surgery, including accredited and nonaccredited centers, and the factors affecting those trends, is lacking.
The objective of this study was to evaluate current trends for postoperative MACE after bariatric surgery in both accredited and nonaccredited centers and the factors affecting these trends.
This retrospective study was conducted using National Inpatient Sample database from 2012 to 2019.
All patients who underwent inpatient laparoscopic sleeve gastrectomy (LSG), open sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and open Roux-en-Y gastric bypass (RYGB) were examined. Composite MACE (acute myocardial infarction, cardiac arrest, acute stroke, and in-hospital death during bariatric surgery hospitalization) was calculated and analyzed over time along with patient demographic and co-morbid diseases using survey-weighted logistic regression.
MACE incidence was lowest for LSG (0.07%), followed by LRYGB (0.16%), SG (3.47%), and RYBG (3.51%). Open procedure, increasing age, male sex, body mass index ≥50, coronary artery disease, congestive heart failure, and chronic kidney disease were independent predictors for increased MACE risk. MACE incidence increased over time for SG (odds ratio [OR] 1.25 [1.16, 1.34]; P < .0001) and RYGB (OR 1.14 [1.06, 1.22]; P = .0004) but decreased for LRYGB (OR 0.93 [0.87, 1] P = .06). After adjustment for high-risk covariates, increased MACE trend seen over time was attenuated in SG (OR 1.13 [1.04–1.22]; P = .005) and RYGB (OR 1.04 [0.96–1.12]; P = .36), while there was minimal effect of these high-risk covariates on MACE trend over time in LSG and LRYGB.
MACE following LSG and LRYGB is rare, occurring in 0.1% of patients. Persistently increasing high-risk conditions and demographics has had minimal effect on MACE over time for LSG and LRYGB but has had significant effect on MACE trend over time in SG and RYGB.
30-day Major Adverse Cardiac Events (MACE) after elective bariatric surgery: the development and validation of the Bari-MACE clinical predictive tool
2022, Surgery for Obesity and Related Diseases
Major adverse cardiac events (MACEs) after bariatric surgery are poorly understood yet are thought to be associated with significant morbidity and mortality.
To evaluate the prevalence and clinical impact of short-term, 30-day MACE and to develop a pragmatic clinical predictive MACE scoring tool.
This retrospective study was conducted using all the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)–accredited center data from 2015 to 2019.
Primary Roux-en-Y and sleeve gastrectomy procedures were included, and prior revisional surgeries and emergency surgeries were excluded. Multivariable logistic regression modeling was used to examine the risk factors associated with 30-day MACE. Using forward regression, a Bari-MACE clinical prediction model was generated.
A total of 750,498 patients were included in our analysis of which 959 (.1%) experienced a MACE. MACE patients were older (54.0 ± 11.5 yr versus 44.4 ± 12.0 yr, P < .0001), and comprised a higher proportion of males (36.3% versus 20.4%, P < .0001) and patients of White racial status (74.0% versus 71.6%, P < .0001). The MACE cohort also had a higher body mass index (46.6 ± 9.7 kg/m² versus 45.2 ± 7.8 kg/m², P < .0001), higher rates of sleep apnea (56.8% versus 38.2%, P < .0001), and a higher proportion of insulin-dependent diabetes (26.1% versus 8.4%, P < .0001) than non-MACE patients. Derivation of our clinical predictive Bari-MACE scoring model revealed 12 variables associated with development of MACE with a specificity of 97.8% using a 55-point threshold.
Thirty-day major adverse cardiac events after elective bariatric surgery are rare, occurring in approximately .1% of all patients, but are associated with significant morbidity and mortality. Using the MBSAQIP, we developed a Bari-MACE clinical predictive tool to risk-stratify patients with the aim to better guide perioperative care and foster improved surgical outcomes.
Surgical, metabolic, and prognostic outcomes for Roux-en-Y gastric bypass versus sleeve gastrectomy: a systematic review
2021, Surgery for Obesity and Related Diseases
Citation Excerpt :
The Critical Appraisal Skills Programme (CASP) checklist was used to assess the quality of evidence in this systematic review [9] (Table 1). Initially 1237 studies were found with 29 studies meeting inclusion criteria [7,10–37]. The last study was accessed on October 14, 2020.
The purpose of this systematic review was to study 4 different aspects of Roux-en-Y gastric bypass (RYBG) and sleeve gastrectomy (SG). Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are two commonly performed bariatric procedures. This systematic review aims to compare RYGB with SG when it comes to weight changes, and cardiometabolic risk profile. Another aim was to evaluate laparoscopic and robotic techniques for both surgeries. PubMED, Cochrane Library, and JAMA Network were searched for articles evaluating RYGB and SG from 2005–2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Four different categories were analyzed comparing RYGB with SG as well as robotic versus laparoscopic approach. The Critical Appraisal Skills Program (CASP) checklist was used to assess the quality of evidence in the studies included in this systematic review. A total of 29 studies were included looking at different aspects of RYGB and SG. RYGB is superior to SG for weight loss, improved or complete remission of cholesterol and hypertensive medications. Consensus is lacking regarding decrease in BMI, total cholesterol, and triglycerides. There is lack of evidence regarding decrease of incidence of MI or stroke. For RYGB and SG, the majority of studies found that the robotic technique was more expensive and took longer. RYGB when compared with SG was associated with larger weight loss, decreased or cessation of cholesterol and hypertensive medications, and lower cholesterol. Decrease in BMI had varying results, with RYGB being superior in more studies, while there was no difference in other studies. There was a lack of evidence to support if RYGB or SG was superior to decreasing triglyceride levels. For both RYGB and SG, the robotic approach was costlier and took more operating time versus the laparoscopic approach.

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Original articleEarly cardiac complications after bariatric surgery: does the type of procedure matter?

Highlights

Abstract

Background

Objective

Setting

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Surgery

J Am Coll Surg

Surg Obes Relat Dis

Ann Med Surg

Surg Obes Relat Dis

Am J Surg

Int J Surg

Surg Obes Relat Dis

Surg Obes Relat Dis

Am J Med

Surg Obes Relat Dis

Assessment of cardiac risk before non-cardiac general surgery

Heart

Predictors of readmission after laparoscopic gastric bypass and sleeve gastrectomy: a comparative analysis of ACS-NSQIP database

Surg Endosc

Assessing risk of critical care complications and mortality in the elective bariatric surgery population using a modified frailty index

Obes Surg

Laparoscopic sleeve gastrectomy is associated with lower 30-day morbidity versus laparoscopic gastric bypass: an analysis of the American College of Surgeons NSQIP

Obes Surg

Original article
Early cardiac complications after bariatric surgery: does the type of procedure matter?