Prior bariatric surgery may halve HF mortality, reduce hospital stay
NASHVILLE, Tenn. — Patients with obesity who undergo bariatric surgery and later develop heart failure are nearly 50% less likely to die of heart failure in the hospital vs. similar patients who did not have prior bariatric surgery, according to a national database analysis presented here.
In an analysis of patients with heart failure (HF) who did and did not undergo prior bariatric surgery, the researchers also found that bariatric surgery was associated with reduced length of stay for hospitalization for HF.
“There are multiple studies showing bariatric surgery improves cardiometabolic risk factors, including diabetes and hypertension, and there are good studies showing bariatric surgery can be cardioprotective,” Ali Aminian, MD, FACS, FASMBS, associate professor of surgery at the Cleveland Clinic, told Endocrine Today. “Despite all of this, there are some patients who develop complications of heart disease, like heart failure. The goal of this study was to see if, in those unfortunate cases, if they develop heart failure, could bariatric surgery be protective or not?”
In a retrospective study, Aminian and colleagues analyzed data from 2,810 patients with a principal discharge diagnosis of HF who also had a history of prior bariatric surgery, identified from the 2007-2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample. Researchers matched these patients 1:5 with patients who had similar principal diagnoses but no history of bariatric surgery (controls). Propensity scores, balanced on baseline characteristics, were used to assemble two control groups. Group 1 included patients with obesity only, defined as BMI at least 35 kg/m². In control group 2, BMI was considered as one of the matching criteria in propensity matching. The total cohort included 33,720 patients. Researchers used regression models to calculate ORs for in-hospital HF mortality and length of hospital stay.
Researchers found that mortality rates after HF admission were lower in patients with a history of bariatric surgery vs. controls in group 1 (0.96% vs. 1.86%; P = .0013) and in control group 2 (0.96% vs. 1.86%; P = .0011).
“Interestingly, when compared with both control groups, there was 50% reduction in mortality,” Aminian said in an interview. “It’s fascinating because we don’t exactly know the underlying mechanism for this. We can assume the surgery improved the risk factors for heart failure or improved the function of organs overall, and if the patient develops heart failure and had bariatric surgery, the overall complication risk might be lower because the organs functioned better.”
Additionally, patients in the prior bariatric surgery group had a shorter mean length of hospital stay vs. controls in groups 1 and 2 (4.8 days vs. 5.7 days and 5.4 days, respectively; P < .001 for both).
“This supports the evidence out there that bariatric surgery does more than protecting patients from developing congestive heart failure,” Essa M. Aleassa, MD, a fellow with Cleveland Clinic, told Endocrine Today after presenting the findings. “It actually helps them when they get an acute attack of heart failure.”
Aleassa said there are study limitations, as it is a retrospective analysis of an administrative database.
There is potential for coding errors and misclassification, he said.
It is important for clinicians and surgeons to assess surgical risk in HF patients to determine who is the best candidate for bariatric surgery, Aleassa said.
“There are studies here at ObesityWeek showing that heart failure is a risk factor for postop complications, so we need to know that the surgical risk could be higher in patients with HF,” Aminian said. “We need to optimize the patients for surgery, but if we can do the surgery safely in those patients, their risk of dying from heart failure could significantly decrease.” – by Phil Neuffer and Regina Schaffer
Aleassa EM, et al. A-105. Presented at: ObesityWeek 2018; Nov. 11-15, 2018; Nashville, Tenn.
Disclosures: Aminian and Aleassa report no relevant financial disclosures.