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Is bariatric surgery safe in patients with history of cardiac revascularization?
Luis Felipe Okida1, Juliana Henrique1, Mauricio Sarmiento-Cobos1
1Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
Insights
Bariatric surgery is safe for patients with prior cardiac revascularization, including coronary artery bypass graft and percutaneous coronary intervention. Outcomes were comparable to those without prior cardiac procedures, with no significant increase in complications.
Area of Science:
- Cardiovascular Surgery
- Bariatric Surgery
- Medical Outcomes Research
Background:
- Increasing number of patients undergoing bariatric surgery have a history of cardiac revascularization (CR).
- Limited data exists on the safety of bariatric procedures in patients with prior CR.
Purpose of the Study:
- To compare cardiovascular and noncardiovascular outcomes after bariatric surgery in patients with different types of prior CR.
- To assess the safety of bariatric surgery in patients with prior CR compared to those without.
Main Methods:
- Retrospective review of 2884 bariatric surgery patients (2009-2018).
- Stratification of 76 patients with prior CR into coronary artery bypass graft (CABG), percutaneous coronary intervention with stent (PCI), and combined CABG + PCI groups.
- Comparison of outcomes between CR groups and with a control group without prior CR.
Main Results:
- No statistically significant differences in complication rates were observed between CR subgroups (PCI, CABG, CABG + PCI).
- Overall 30-day cardiovascular and noncardiovascular complication rates were 9.2% and 10.5%, respectively.
- No significant difference in complications was found when comparing patients with prior CR to the control group (P > .05).
Conclusions:
- Bariatric surgery is a safe procedure for patients with prior cardiac revascularization.
- Despite severe comorbidities, revascularized patients experience comparable outcomes to those without prior CR when undergoing bariatric surgery.
Background:
The number of patients undergoing bariatric surgery with prior cardiac revascularization (CR) is rising. However, scarce data exist regarding the safety of bariatric procedures in these patients.
Objectives:
The aim of this study is to compare postoperative cardiovascular and noncardiovascular outcomes among patients with different CR procedures.
Setting:
Academic hospital, United States.
Methods:
We retrospectively reviewed 2884 patients undergoing bariatric surgery from 2009-2018. Patients with prior CR were included and stratified into groups: coronary artery bypass graft (CABG), percutaneous coronary intervention with stent (PCI), and CABG + PCI. We described patient demographic characteristics, co-morbidities, smoking status, history of myocardial infarction, type of bariatric surgery, number of vessels grafted/stents, time from CR to bariatric surgery, length of stay, and cardiovascular and noncardiovascular 30-day outcomes. A control group composed of patients without prior CR undergoing bariatric surgery was used to compare the rate of complications to the total patients with prior CR. For continuous and categorical variables, t test and χ2 tests were performed, respectively.
Results:
We identified 76 patients with prior CR undergoing bariatric surgery. The mean patient age was 61.4 ± 7.9 years, the mean body mass index was 41.7 ± 6.5 kg/m2, and male sex was predominant (71.1%). Among these, 50% (n = 38) had PCI, 39.4% (n = 30) had CABG, and 10.5% (n = 8) had CABG + PCI. Early cardiovascular complications rate included ST-segment-elevation myocardial infarction (n = 2), pulmonary embolism (n = 1), supraventricular arrhythmia (n = 2), ventricular arrhythmia (n = 1), and pacemaker/defibrillator-insertion (n = 1). The overall rate of cardiovascular and noncardiovascular complications was 9.2% (n = 7) and 10.5% (n = 8) during the 30 days. Mortality rate was 0%. Comparison of rate of complications between groups did not show any statistical difference; no significant difference was found when comparing patients with prior CR to the 76 patients in the control group (P > .05).
Conclusions:
Although revascularized individuals have severe co-morbidities and are high-risk patients, bariatric surgery remains safe in this population when outcomes are compared with bariatric patients without prior CR.
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