Impact of heart failure on postoperative outcomes in bariatric surgery

The rising prevalence of heart failure (HF) and coexisting metabolic syndrome underscores the need to better understand how these conditions affect postoperative outcomes following metabolic and bariatric surgery.

To test the hypothesis that HF is associated with a greater risk of postoperative morbidity following metabolic and bariatric surgery.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.

Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the year 2023, postbariatric surgery complications of patients with a history of HF (n = 3422) were compared with patients without HF (n = 3422) using 1:1 propensity matching. Composite 30-day outcomes included length of stay (LOS) > 5 days (LOS > 5), infectious complications, serious complications, major adverse cardiovascular and cerebrovascular events, and death.

Compared to matched controls, HF patients had higher incidence of prolonged LOS > 5 days (4.49% vs. 1.66%, P < .001) and increased rates of infectious (3.07% vs. 1.72%, P < .001) and serious complications (5.26% vs. 2.70%, P < .001). No differences were observed in major adverse cardiovascular events (.53% vs. .35%, P = .36) or 30-day mortality (.68% vs. .38%, P = .12).

A history of HF in patients undergoing bariatric surgery is associated with significant increases in major postoperative morbidity. Efforts directed toward preoperative optimization of patients with HF and attentive postoperative monitoring as warranted. Further research is necessary to determine optimal perioperative management of patients with HF undergoing metabolic surgery.