David Gutierrez Blanco, MD, David Romero Funes, MD, Giulio Giambartolomei, MD, Mauricio Sarmientos Cobos, MD, Emanuele Lo Menzo, MD, PhD, FACS, Rama Ganga, MD, Samuel Szomstein, MD, FACS, Raul J Rosenthal, MD, FACS. Cleveland Clinic Florida
INTRODUCTION: Atherosclerotic cardiovascular disease(ASCVD) and Framingham risk scores(FRS) are used to calculate the 10-year risk of coronary death or nonfatal myocardial infarction or fatal/nonfatal stroke. Our goal is to evaluate the association of preoperative cardiovascular risk and weight loss.
METHODS: We retrospectively reviewed all bariatric surgeries at our institution between 2010 and 2016. Patients who met the criteria for calculating the 10-year ASCVD score and FRS were included. Data collected included baseline demographics, perioperative parameters and postoperative outcomes at 12 months. Simple linear regression and multiple linear regression models were applied to test the influence of individual or multiple factors of interest on 12 months weight loss outcomes.
RESULTS: Of the 1330 bariatric patients studied, 360 (27.06%) patients met the criteria for ASCVD and FRS calculation. Laparoscopic sleeve gastrectomy (LSG) was the most prevalent surgery 63.05% (N=227), followed by laparoscopic Roux-en-Y gastric bypass (LRYGB) 20.55%(N=74), revision procedures 11.9%(n=43), and laparoscopic adjustable gastric banding(LAGB) 4.4%(n=16). Females composed 70.27% (N=253) of our population. The female’s average age was 50.93±11.87years and males was 54.89±10.9years. The initial BMI was 42.71±7.85kg/m2 for females and 42.72k±7.42kg/m2 for males, with a 12 months percentage of estimated BMI loss (%EBMIL) of 66.51% in females and 60.29% in males. The preoperative 10-year ASCVD score was higher in males compared to females (17.11±13.3% vs. 7.97±8.8% respectively) with a 34.73% relative risk reduction (RRR) in males and 35.3% RRR in females at 12 months follow-up. Regarding the FRS the preoperative risk was 33.13±21.1% in males and 15.71±14.52% in females with an RRR of 25.8% in males and 32.2% in females. Univariate analysis of preoperative FRS and %EBMIL showed that for every percentage unit increase in the patient’s preoperative FRS, the %EBMIL decreases 0.31 percentile unit (p<0.001). Furthermore, preoperative ASCVD score is also significantly associated with %EMBIL meaning that for every percentage unit increase in the preoperative ASCVD score, the %EBMIL decreases 0.42 percentile credits.
CONCLUSION: Our results suggest that the atherosclerotic cardiovascular disease and Framingham risk score are equally reduced after bariatric surgery, especially after LSG and LRYGB, Moreover, the preoperative FRS and ASCVD risk scores had a significant impact in weight loss showing an inversely proportional relationship with the %EBMIL loss at 12 months.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87054
Program Number: S027
Presentation Session: Bariatrics 1 Session
Presentation Type: Podium