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Early cardiac complications after bariatric surgery: does the type of procedure matter?
Zhamak Khorgami1, Theresa N Jackson1, Ali Aminian2
1Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, Oklahoma.
Insights
Cardiac complications after bariatric surgery are rare but increase mortality risk. Older age, male sex, and heart/lung conditions predict these events, not the surgical type (SG vs. RYGB).
Area of Science:
- Cardiology
- Bariatric Surgery
- Surgical Outcomes
Background:
- Major adverse cardiac events (MACE) contribute to postoperative mortality, particularly in bariatric surgery patients due to obesity-related cardiovascular risks.
- Understanding cardiac event predictors is crucial for patient safety in bariatric procedures.
Purpose of the Study:
- To evaluate the incidence of postoperative cardiac adverse events following bariatric surgery.
- To identify independent predictors of these cardiac events.
Main Methods:
- Retrospective analysis of the 2011-2015 Healthcare Cost and Utilization Project-National Inpatient Sample.
- Included patients undergoing laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).
- MACE defined as myocardial infarction, acute ischemic heart disease, or acute heart failure; dysrhythmia analyzed separately. Multivariate regression used to identify predictors.
Main Results:
- Analysis of 108,432 patients revealed MACE in 0.1% and dysrhythmia in 3.4%.
- MACE was associated with longer hospital stays (4.5 vs. 2 days) and increased mortality (31 deaths).
- Independent predictors of MACE included age ≥ 50, male sex, congestive heart failure, chronic pulmonary disease, ischemic heart disease, pulmonary emboli history, and fluid/electrolyte disorders. Surgical type (SG vs. RYGB) was not a predictor.
Conclusions:
- Cardiac complications, though rare after bariatric surgery, significantly increase length of stay, hospital charges, and mortality.
- Predictors of MACE include advanced age, male sex, pre-existing cardiopulmonary conditions, and fluid/electrolyte imbalances.
- Roux-en-Y gastric bypass (RYGB) does not confer a higher risk of MACE compared to sleeve gastrectomy (SG).
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.
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