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Development of a bariatric surgery specific risk assessment tool for perioperative myocardial infarction

Amlish Bilal Gondal1, Chiu-Hsieh Hsu1, Rostam Khoubyari2

  • 1University of Arizona, Department of Surgery, Tucson, Arizona.

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery
|January 29, 2019
PubMed
Abstract

Insights

Perioperative myocardial infarction (MI) after bariatric surgery is rare but carries high mortality. A new risk score identifies patients needing focused cardiac evaluation, improving outcomes for this intermediate-risk procedure.

Area of Science:

  • Cardiology
  • Bariatric Surgery
  • Surgical Outcomes

Background:

  • Perioperative myocardial infarction (PMI) is a significant concern following surgical procedures.
  • Bariatric surgery, while intraabdominal, has limited data regarding PMI rates and predictors.
  • Understanding PMI prevalence is crucial for patient safety in bariatric procedures.

Purpose of the Study:

  • To determine the incidence of PMI in patients undergoing bariatric surgery.
  • To develop and validate a predictive tool for identifying patients at risk of PMI.
  • To aid clinicians in stratifying risk and guiding perioperative cardiac care.

Main Methods:

  • Analysis of the 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participant use file (PUF).
  • Multivariable regression identified preoperative factors associated with PMI.
  • A risk scoring tool was developed using 2016 data and validated with the 2015 PUF.

Main Results:

  • The study analyzed 172,017 patients, with a 30-day PMI event rate of 0.03%.
  • Mortality for patients experiencing PMI was 17.3%.
  • Key predictors for PMI included prior MI, renal insufficiency, hyperlipidemia, and age over 50, forming the basis of the risk score.

Conclusions:

  • The incidence of PMI post-bariatric surgery is lower than in other intraabdominal surgeries, but associated mortality is high.
  • A validated risk assessment tool can effectively identify patients requiring enhanced perioperative cardiac assessment.
  • This tool empowers bariatric surgeons to optimize care for high-risk individuals, potentially reducing PMI complications.
Keywords:
Bariatric surgeryMortalityPerioperative myocardial infarctionRisk stratification

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