Effect of High Risk factors on Postoperative Major Adverse Cardiovascular and Cerebrovascular Events Trends following bariatric surgery in US from 2012-2019.


Background

Recent examination of trends in postoperative major adverse cardiovascular and cerebrovascular
events (MACE) following Bariatric Surgery (BaS), including accredited and non-accredited
centers, and the factors affecting those trends, is lacking.

Objectives

To evaluate current trends for postoperative MACE after BaS in both accredited and
non-accredited centers and the factors affecting these trends.

Settings

This retrospective study was conducted using National Inpatient Sample database from
2012 -2019

Methods

All patients who underwent inpatient Laparoscopic Sleeve Gastrectomy (LSG), Open Sleeve
Gastrectomy (SG), Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), and Open Roux-en-Y
Gastric Bypass (RYGB) were examined. Composite MACE (acute myocardial infarction,
cardiac arrest, acute stroke, and in-hospital death during BaS hospitalization) was
calculated and analyzed over time along with patient demographic and comorbid diseases
using survey-weighted logistic regression.

Results

MACE incidence was lowest for LSG (0.07%), followed by LRYGB (0.16%), SG (3.47%) and
RYBG (3.51%). Open procedure, increasing age, male sex, body mass index ≥50, coronary
artery disease, congestive heart failure, and chronic kidney disease were independent
predictors for increased MACE risk. MACE incidence increased over time for SG (OR
1.25 [1.16,1.34] p<0.0001) and RYGB (OR 1.14 [1.06,1.22] p=0.0004), but decreased
for LRYGB (OR: 0.93 [0.87,1] p=0.06). After adjustment for high-risk co-variates,
increased MACE trend seen over time was attenuated in SG (OR 1.13 [1.04 -1.22] p=0.005)
and RYGB (OR 1.04 [0.96-1.12] p=0.36). While there was minimal effect of these high-risk
co-variates on MACE trend over time in LSG and LRYGB.

Conclusion

MACE following LSG and LRYGB is rare, occurring in 0.1% of patients. Persistently
increasing high risk conditions and demographics have had minimal effect on MACE over
time for LSG and LRYGB but have had significant effect on MACE trend over time in
SG and RYGB.



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