Abstract 211: Association of Bariatric Surgery With Major Adverse Cardiovascular Outcomes: Insights From the National Inpatient Sample 2012-2016

Abstract

Background: Approximately one in every three people in the United States has obesity. There is a strong association between obesity and an increased rate of cardiovascular disease (CVD)-related mortality. Bariatric surgery (BS) refers to a variety of procedures performed to achieve a reduction of excess weight. Many small randomized controlled trials and observational studies have demonstrated the association between BS and reduction in major adverse cardiac events (MACEs) among patients with obesity and Type 2 diabetes. However, these studies have been limited by small sample sizes, localized database, or inclusion of surgical procedures no longer commonly used. Our study aims to explore the relationship between BS and inpatients MACEs among obese inpatients in the United States, using a large and contemporary national database. Methods: This is a retrospective study using the National Inpatient Sample between 2012 and 2016. Adult obese patients with BMI ≥35 (ICD 9/10 codes V85.35, V85.4x/ Z68.35, Z68.4x) were included (n= 1,700, 943). First, a univariate analysis was performed to study differences in clinical characteristics between obese patients with BS status (identified by ICD9/10 codes V45.86 / Z98.84, respectively) versus obese patients without BS status. A logistic regression model was then constructed to study the association between undergoing BS and having MACEs, including all-cause mortality, cardiac arrest, acute heart failure, acute myocardial infarction (MI), and cerebrovascular accident after adjusting for CVD risk factors such as gender, diabetes, hypertension, hyperlipidemia, prior MI, chronic kidney disease, atrial fibrillation, and smoking. Results: Among 50, 296 patients with BS (2.96%), the mean age was 53 ± 12 years; the majority was female (75.32%), Caucasian (71.85%) and from the hospital region of the South (33.73%). 33.92% had diabetes, 53.27% had hypertension, and 29.60% had hyperlipidemia. Multivariable analysis revealed that obese patients with BS status had a 1.6-fold decrease in the rate of MACEs compared to patients without BS (odds ratio, 0.623; 95% CI, 0.598-0.649; P<0.001). Conclusion: The study illustrated that among obese patients with BMI ≥35, a history of bariatric surgery was associated with a statistically significant lower risk of inpatient MACEs, after adjusting for CVD risk factors.