Victoria M Gershuni, MD, MSGM, Michael W Foster, MD, Colleen M Tewksbury, PhD, MPH, RD, Eduardo Rame, MD, Kristoffel R Dumon, MD, Noel N Williams, MD. Hospital of the University of Pennsylvania
Introduction: Severe obesity and its related complications, including hyperlipidemia, hypertension, insulin resistance, and obstructive sleep apnea (OSA), confer increased risk of developing cardiac disease. Paradoxically, patients with overweight and obesity have lower cardiac-related mortality than their normal-weight, cardiovascular risk-adjusted counterparts, which suggests that obesity may exert a slightly protective effect in this population. It is unclear, however, whether cardiac disease portends worse surgical outcomes following bariatric surgery.
Methods: Using the MBSAQIP Participant Use Data File, a retrospective analysis of patients undergoing laparoscopic and laparoscopic-assisted Roux-en-Y Gastric Bypass (LRYGB) or sleeve gastrectomy (LSG) between 2016-2017 was performed. Patients were classified as having cardiac disease by history of prior myocardial infarction (MI), percutaneous coronary intervention (PCI), or cardiac surgery. Patients were assessed for 30-day mortality and incidence of peri-operative cardiac arrest/need for CPR.
Results: Of patients undergoing bariatric surgery (n=325,653), 4,405 have history of MI, 7,097 have had PCI, and 3,774 have had prior cardiac surgery. Compared to the rest of the cohort, cardiac patients (3.5%) had a greater number of comorbidities as demonstrated by increased prevalence of hypertension (88.9% vs. 47.7%, p<0.0001), hyperlipidemia (71.2% vs. 23.2%, p<0.0001), diabetes (54.6% vs. 25.8%, p<0.0001), and renal insufficiency (4.1% vs. 0.54%, p<0.0001). Prior MI, PCI, and cardiac surgery were each associated with significantly increased risk of intra-operative cardiac arrest requiring CPR (RR: 5.65; 95% CI 3.1-10.4, RR 4.88, 95% CI: 2.9-8.3, RR: 7.26; 95% CI 4.0-13.1, respectively) and 30-day mortality (RR: 4.29; 95% CI 2.7-6.8, RR 3.85, 95% CI: 2.6-5.7, RR 4.46, 95% CI: 2.7-7.3, respectively).
Conclusion: Patients with significant pre-existing cardiac disease as indicated by prior cardiac intervention were at greatly increased risk for perioperative mortality, either at time of surgery or in the initial 30 days following the operation. Severe obesity is a known risk factor for cardiac disease suggesting benefit for bariatric surgery in this population; however, cardiac patients undergoing bariatric surgery may require additional preoperative treatment, perioperative interventions, and postoperative monitoring.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95376
Program Number: P054
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster