Association Between Delayed Metabolic and Bariatric Surgery Completion and Postoperative Cardiometabolic Outcomes

Delays in completion of metabolic and bariatric surgery (MBS) remain common and may adversely affect postoperative cardiometabolic recovery. This study examined whether delayed MBS completion was associated with differences in postoperative cardiometabolic outcomes over 24 months.

This prospective longitudinal cohort study included 413 adults referred to MBS from academic and community-based programs in Texas. Of these, 172 participants completed MBS within the study period and comprised the analytic sample for the present analysis. Repeated measures of weight and cardiometabolic biomarkers were collected before MBS and 6, 12- and 24-months post-MBS. Generalized estimating equations were used to evaluate associations between cardiometabolic biomarkers (anthropometrics, HbA1c, lipids), timing of MBS completion (early completion: ≤3 months after referral; delayed completion: >3 to 15 months after referral), adjusting for covariates.

Among 172 adults who completed MBS, 66 completed surgery within 3 months of referral, and 106 completed surgery > 3 to 15 months post-referral. Among early completers, the median time from referral to surgery was 2.0 months (IQR 0.7-4.3), compared with 5.6 months (IQR 3.2-9.6) among delayed completers. Participants identified as 39.2% Non-Hispanic White, 39.0% Non-Hispanic Black, and 17.6% Hispanic. After multivariable adjustment, delayed MBS completers had higher total cholesterol (β = 14.52, 95% CI = 1.70 to 27.33, p = 0.026), higher non-HDL cholesterol (β = 16.96, 95% CI = 5.31 to 28.61, p = 0.004), higher cholesterol/HDL ratio (β = 0.43, 95% CI = 0.06 to 0.81, p = 0.024), and higher hemoglobin A1c levels (β = 0.36, 95% CI = 0.07 to 0.65, p = 0.016) compared to early completers post-MBS. Triglyceride levels were reduced significantly at 6 months (p < 0.001), 12 months (p = 0.002), and 24 months (p < 0.001). HDL levels increased significantly at 24 months (p < 0.001), whereas non-HDL cholesterol levels (p = 0.014) and cholesterol/HDL ratio (p = 0.001) reduced significantly at 24 months only. Weight, glucose, and HbA1c levels also decreased significantly over 24 months post-MBS (p < 0.05). A significant sex-specific effect was observed with women demonstrating higher levels of total cholesterol (p < 0.001), HDL (p < 0.001), LDL (p = 0.001), and non-HDL cholesterol (p = 0.001) compared to men.

Delayed completion of MBS was associated with less favorable postoperative cardiometabolic profiles, including higher total cholesterol, non-HDL cholesterol, cholesterol/HDL ratio, and HbA1c levels over 24 months following surgery. These findings support efforts to reduce delays in access to MBS and optimize timely surgical care.