Bariatric surgery reduces mortality risk following MI, stroke
Adults with obesity who undergo bariatric surgery are less likely to die from a myocardial infarction or stroke compared with adults who do not undergo bariatric surgery whether or not they have obesity at the time of the event, according to findings published in Diabetes, Obesity and Metabolism.
“Our understanding of the magnitude of the cardiometabolic effects of bariatric surgery continues to grow as analyses shed light on the surgical treatment of obesity-related comorbidities and the potential survival benefits,” Ali Aminian, MD, FACS, FASMBS, associate professor of surgery at the Cleveland Clinic, and colleagues wrote. “Numerous studies have demonstrated that bariatric surgery can significantly reduce the relative risk and incidence of several adverse health events and even reduce overall mortality.”
Aminian and colleagues examined information from the National Inpatient Sample between 2007 and 2014 and compared data from 2,218 adults (mean age, 58.86 years; 62.9% women) with MI who had previous bariatric surgery with data from 11,090 adults (mean age, 59.6 years; 62.8% women) with MI, no previous bariatric surgery and a BMI of 35 kg/m2 or more. They compared data from 2,168 adults (mean age, 59.76 years; 73% women) who experienced a cerebrovascular accident who had previous bariatric surgery with data from 10,840 adults (mean age, 60.84 years; 72.2% women) with a cerebrovascular accident, no previous bariatric surgery and a BMI of 35 kg/m2 or more. Those with a BMI of 35 kg/m2 or more were considered to have morbid obesity.
The researchers also compared data from 1,849 adults who had previous bariatric surgery and an MI (mean age, 59.05 years; 62.7% women; 48.2% with obesity) with data from 9,245 BMI-matched adults without bariatric surgery and an MI (mean age, 59.8 years; 62.7% women; 48.1% with obesity), and data from 1,815 adults who had previous bariatric surgery and a cerebrovascular accident (mean age, 59.96 years; 72.6% women; 36.1% with obesity) with data from 9,075 BMI-matched adults who had a cerebrovascular accident and no bariatric surgery (mean age, 60.72 years; 72.5% women; 36.1% with obesity).
Compared with the group with morbid obesity, the bariatric surgery group had a lower mortality rate following MI (3.03% vs. 1.85%; P = .004) and less mortality risk related to MI (OR = 0.61; 95% CI, 0.44-0.86). Similarly, compared with the group matched by BMI, the surgery group had a lower mortality rate following MI (3.26% vs. 2%; P = .008) and lower mortality risk due to the event (OR = 0.62; 95% CI, 0.44-0.88).
The average length of stay in-hospital for MI was more than 4 days for those with morbid obesity and no surgery (4.88 days) and those in the BMI-matched group (4.34 days) and fewer than four 4 days for those with previous bariatric surgery vs. with the group with morbid obesity (3.79 days) and those who had surgery and were BMI-matched (3.82 days; P < .001 for all), the researchers wrote.
Among all participants who underwent bariatric surgery and later had a cerebrovascular accident, there was a 1.43% mortality rate compared with 2.74% in the group with morbid obesity (P = .001). Participants who had bariatric surgery and were BMI-matched had a 1.54% mortality rate related to cerebrovascular accidents compared with 2.59% for the BMI-matched group without surgery (P = .015). Mortality risk was also lower for those with previous bariatric surgery compared with those with morbid obesity (OR = 0.54; 95% CI, 0.37-0.79) and the BMI-matched group (OR = 0.61; 95% CI, 0.41-0.91), according to the researchers.
The average length of stay in-hospital for cerebrovascular accident was more than 4 days for those with morbid obesity and no surgery (4.8 days) and those in the BMI-matched group (4.42 days) and fewer than four 4 days for those with previous bariatric surgery (3.89 days for both surgery groups; P < .001 for all).
“Bariatric surgery has demonstrated a remarkable capability of improving or resulting in long-term remission of dozens of obesity-related derangements,” the researchers wrote. “This impressive metabolic effect can occur in a weight-independent fashion, suggesting far more complex pathways than simple weight-loss alone.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.