Early cardiac complications after bariatric surgery: does the type of procedure matter?
BACKGROUND
Major adverse cardiac events (MACE) can be a cause of postoperative mortality. This is specifically important in bariatric surgery due to obesity-related cardiovascular risk factors.


OBJECTIVE
To assess postoperative cardiac adverse events after bariatric surgery and its independent predictors.


SETTING
A retrospective analysis of 2011-2015 Healthcare Cost and Utilization Project-National Inpatient Sample.


METHODS
Data on patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were retrieved. MACE was identified as a composite variable including myocardial infarction, acute ischemic heart disease without myocardial infarction, and acute heart failure. Dysrhythmia (excluding premature beats) was identified as a separate outcome. Multivariate regression analysis for MACE was performed using demographic factors, co-morbidities, and type of surgery.


RESULTS
The analysis included 108,432 patients (SG: 54.6%, RYGB: 45.4%). MACE was found in 116 patients (.1%), and dysrhythmia occurred in 3670 patients (3.4%). Median length of stay in patients with MACE was 4.5 versus 2 days in others (P < .001). There were 43 deaths overall, and 31 were in patients with MACE or dysrhythmia (P < .001). Age ≥ 50 years, male sex, congestive heart failure, chronic pulmonary disease, ischemic heart disease, history of pulmonary emboli, and fluid or electrolyte disorders were independent predictors of MACE based on multivariate analysis. Type of surgery (SG versus RYGB) was not an independent predictor for MACE (odds ratio 1.41, 95% confidence interval: .77-2.55).


CONCLUSIONS
While cardiac complications are rare after bariatric surgery, their occurrence is associated with increased length of stay, hospital charges, and mortality. Older age, male sex, cardiopulmonary co-morbidities, and fluid or electrolyte disorders are predictive of MACE. RYGB does not increase the risk of MACE compared with SG.
['Khorgami|Zhamak|Z|', 'Jackson|Theresa N|TN|', 'Aminian|Ali|A|', 'Sahawneh|James M|JM|', 'Sclabas|Guido M|GM|', 'Chow|Geoffrey S|GS|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D002318:Cardiovascular Diseases D005260:Female D005743:Gastrectomy D015390:Gastric Bypass D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D009767:Obesity, Morbid D011183:Postoperative Complications D012189:Retrospective Studies D016896:Treatment Outcome D015431:Weight Loss D055815:Young Adult
Cardiac complication Bariatric surgery Mortality Sleeve gastrectomy Gastric bypass Myocardial infarction Heart failure Morbid obesity