History Of Metabolic Surgery Research Articles

Association of prior metabolic surgery with outcomes after cardiac operations

BackgroundMetabolic surgery has been shown to partially reverse metabolic and cardiovascular derangements associated with obesity. Using a national database, we examined the association of prior metabolic surgery with outcomes after elective cardiac operations. MethodsThe 2016 to 2019 Nationwide Readmissions Database was queried to identify all adult hospitalizations for elective cardiac operations. Individual comorbidities and history of metabolic surgery were ascertained using International Classification of Diseases 10th Revision diagnosis codes. Entropy balancing was used to adjust for differences in baseline characteristics between patients with and without prior metabolic surgery. Multivariable logistic and linear regressions were subsequently developed to assess the association between metabolic surgery and in-hospital mortality, perioperative complications, length of stay, costs, and 30-day unplanned readmission. ResultsAn estimated 454,506 hospitalizations entailing elective cardiac operations met inclusion criteria, of whom 3,615 (0.80%) had a diagnosis code indicating a history of metabolic surgery. Compared to their counterparts, those with prior metabolic surgery were more frequently female, younger, and had a higher burden of comorbidities as measured by the Elixhauser Comorbidity Index. After adjustment, prior metabolic surgery was associated with significantly reduced mortality (adjusted odds ratio 0.50, 95% confidence interval 0.31–0.83). Prior metabolic surgery was also linked to decreased pneumonia, prolonged mechanical ventilation, and respiratory failure. Of note, patients with a history of metabolic surgery encountered a greater likelihood of 30-day, non-elective readmission (adjusted odds ratio 1.26, 95% confidence interval 1.08–1.48). ConclusionsPatients with a history of metabolic surgery had significantly reduced odds of in-hospital mortality and perioperative complications after cardiac operations but faced increased readmissions.

The impact of bariatric surgery on the risk of coronary revascularization.

Metabolic surgery is associated with improved cardiovascular risk profile. Randomized and observational studies exploring the impact of bariatric surgery on follow-up coronary revascularization (CR) as a primary endpoint are limited. To identify the impact of metabolic surgery on the risk of follow-up CR, including percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG) SETTING: Stony Brook Department of Surgery, Stony Brook University Hospital, New York, United States. A retrospective analysis was performed for patients with obesity between 2006 and September 2015. Patients were divided into those with history of metabolic surgery and those without. Patient were also stratified by bariatric surgery type. All study groups were followed till 2018 and for at least 3 years to monitor the development of the primary endpoint-any CR including PCI or CABG. The study population with obesity was 515,307 patients; 95,901 with history of surgery versus 419,406 matched patients without. A total of 12,873 (13.4%) with surgery and 51,478 (12.27%) without were lost to follow-up by 2018. The group with history of surgery had a reduced risk of future CR (hazard ratio [HR], .46; 95% confidence interval [CI]: .42-.50; P < .0001), PCI (HR, .45; 95% CI: .41-.49; P < .0001) and CABG (HR, .49; 95% CI:.42-.56; P < .0001). In subgroup analysis, laparoscopic adjustable gastric banding compared with Roux-en-Y gastric bypass (RYGB) was associated with higher follow-up CR (HR, 1.34; 95% CI: 1.11-1.63; P < .01) and PCI (HR, 1.34; 95% CI: 1.07-1.68; P < .05). Bariatric surgery is associated with reduced risk of future CR, PCI, and CABG. Upon subgroup analysis, RYGB was associated with reduced risk of PCI and CR.

Transformation of bariatric and metabolic surgery principles

Obesity-induced insulin resistance and meta-bolic syndrome continue to pose an important public health challenge worldwide. Metabolic surgery was developed with the aim of weight reduction. In recent years, authors have witnessed great advancement in metabolic surgery, including the development of new and safe procedures or devices. During the last decade, improvements in glycemic control and decreases in cardiovascular events and mortality after surgery have been consistently reported. Therefore, there is an urgent need to identify the type of patients that may benefit the most from metabolic surgery, morbidly obese or not, and selection criteria must be reviewed and updated based on the current surgical outcomes. This article reviews the history of metabolic surgery and summarizes the new perceptions in obesity treatment. Key words: Obesity; Metabolic syndrome; Metabolic surgery