Abstract 13: Prior Bariatric Surgery is Associated With Reduced Risk of Recurrent Stroke Among Elderly Obese Stroke Survivors: A National Inpatient Sample Study (2016-2019)

Abstract

Introduction: The paucity of large-scale data exploring the effect of prior bariatric surgery on recurrent stroke outcomes in elderly obese stroke survivors led us to address the gap, with an emphasis on the risk of recurrent stroke and its trends. Methods: A retrospective study was conducted using National Inpatient Sample data from 2016-2019. Elderly obese stroke survivors (> 65 years) having a recurrent acute ischemic stroke (AIS), with or without prior bariatric surgery (PBS), were identified using ICD-10 codes. We compared recurrent stroke trends, demographic characteristics, and comorbidities between the cohorts, employing multivariable and other statistical analyses. Results: The study included 643,505 elderly obese stroke survivors, of which 1.8% (11,820) had PBS. Both groups (PBS vs. no PBS) were predominantly female (59.7% vs. 73.7%), identified as white (76.5% vs. 83.8%), and covered by Medicare (91.7% vs. 90.7%). Despite being the most prevalent comorbidity, hypertension (83.6% vs. 83.2%) was not significantly associated with bariatric surgery status, followed by hyperlipidemia (68.2% vs. 61.6%), diabetes mellitus (60% vs. 52.2%), tobacco use (37.5% vs. 36.4%), prior myocardial infarction (12.8% vs. 15.7%), peripheral vascular disease (8.8% vs. 11.9%), valvular disease (3.9% vs. 3.5%), and drug abuse (1.6% vs. 1.1%). Between 2016 and 2019, recurrent AIS decreased in the PBS group (from 4% to 2.9%, p=0.035) whilst remaining stable in the other group (4.4% to 4.2%, p=0.064). The PBS group exhibited a significantly lower adjusted odds ratio for recurrent AIS (aOR: 0.77, 95% CI: 0.60 - 0.98). Conclusion: Prior bariatric surgery in elderly obese stroke survivors was associated with a 23% lower risk of recurrent AIS and a decreasing trend of AIS recurrence over time. These findings could influence clinical practice and contribute to developing secondary prevention strategies for recurrent stroke among these patients.