Relation of Bariatric Surgery to Inpatient Cardiovascular Outcomes (from the National Inpatient Sample)

Nguyen, Tran; Alzahrani, Talal; Mandler, Ari; Alarfaj, Mohammed; Panjrath, Gurusher; Krepp, Joseph

doi:10.1016/j.amjcard.2020.12.049

Cited by 19 publications

(12 citation statements)

References 26 publications

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“…Next, we carried out a sensitivity analysis by excluding studies containing an unequal sample size between the arms from the analysis. As shown in the forest plot (Figure 6), following the exclusion of studies with an unequal sample size [24,25,32], the results remained stable. In addition, when each study was sequentially excluded to assess the stability of the results, no study affected the pooled estimates.…”

Section: Sensitivity Analysismentioning

confidence: 84%

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Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

et al. 2021

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Cardiovascular diseases (CVDs) are the leading cause of death worldwide and obesity is a major risk factor that increases the morbidity and mortality of CVDs. Lifestyle modifications (e.g., diet control, physical exercise and behavioral changes) have been the first-line managements of obesity for decades. Nonetheless, when such interventions fail, pharmacotherapies and bariatric surgery are considered. Interestingly, a sudden weight loss (e.g., due to bariatric surgery) could also increase mortality. Thus, it remains unclear whether the bariatric surgery-associated weight reduction in patients with obesity and CVDs is beneficial for the reduction of Major Adverse Cardiovascular Events (MACE). Here, we performed a systematic literature search and meta-analysis of published studies comparing MACE in patients with obesity and CVDs who underwent bariatric surgery with control patients (no surgery). Eleven studies, with a total of 1,772,305 patients, which consisted of 74,042 patients who underwent any form of bariatric surgery and 1,698,263 patients with no surgery, were included in the systematic review. Next, the studies’ data, including odds ratio (OR) and adjusted hazard ratio (aHR), were pooled and analyzed in a meta-analysis using a random effect model. The meta-analysis of ten studies showed that the bariatric surgery group had significantly lower odds of MACE as compared to no surgery (OR = 0.49; 95% CI 0.40–0.60; p < 0.00001; I2 = 93%) and the adjustment to confounding variables in nine studies revealed consistent results (aHR = 0.57; 95% CI 0.49–0.66; p < 0.00001; I2 = 73%), suggesting the benefit of bariatric surgery in reducing the occurrence of MACE in patients with obesity and CVDs (PROSPERO ID: CRD42021274343).

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Section: Sensitivity Analysismentioning

confidence: 84%

“…Nguyen et al [32] analyzed the data of 1700,943 individuals from the 2012-2016 United States National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). A total of 1650,647 participants were included in the control group and 50,296 participants in the surgery group.…”

Section: Highlights Of the Included Studiesmentioning

confidence: 99%

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

et al. 2021

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“…Nguyen et al . (25) employed data of 1,700,943 subjects from the 2012-2016 United States National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). A total of 1,650,647 subjects were included in the control group and 50,296 subjects in the surgery group.…”

Section: Resultsmentioning

confidence: 99%

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Obese Patients with Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Sutanto

2021

Preprint

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Cardiovascular diseases (CVDs) are the leading cause of death worldwide and obesity is a major risk factor which increases morbidity and mortality of CVDs. Lifestyle modifications (e.g., diet control, physical exercise and behavioral changes) have been the first-line managements of obesity for decades. Nonetheless, when such interventions fail, pharmacotherapies and bariatric surgery are considered. Interestingly, a sudden weight loss (e.g., due to bariatric surgery) could also increase mortality (i.e., obesity paradox). Thus, it remains unclear whether the bariatric-surgery-associated weight reduction in patients with obesity and CVDs is beneficial for the reduction of Major Adverse Cardiovascular Events (MACE). Here, we performed a systematic literature search and meta-analysis of published studies comparing the MACE in patients with obesity and CVDs underwent bariatric surgery with control patients (no surgery). Studies data, including odds ratio (OR), were pooled and analyzed in a meta-analysis using a random effect model. Ten studies with a total of 1,772,305 patients, consisted of 74,042 patients underwent any form of bariatric surgery and 1,698,263 patients with no-surgery, were included in the meta-analysis. A random effect model was employed for analysis and showed that bariatric surgery group had significantly lower odds of MACE as compared to no surgery (OR = 0.49; 95% CI 0.40-0.60; p<0.00001; I2=93%), suggesting the benefit of bariatric surgery in reducing the occurrence of MACE in obese patients with CVDs.

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“…Intriguingly, we found a very low number of deaths in the BS group in the long-term when compared to non-BS controls, in line with another large Italian cohort study [ 35 ]. The reduction of mortality could be justified by the substantial weight loss, leading to the improvement/remission of dysmetabolic abnormalities, cardiovascular, respiratory, renal outcomes, cancer reduced risk, and better motility and quality of life reported after BS [ 3 , 12 , 16 , 17 , 18 , 20 , 22 , 23 , 36 , 37 ]. This is not surprising if the effects of excess fat deposition, such as increased oxidative stress, chronic inflammation, endothelial dysfunction, ectopic lipid deposition, impairments in metabolism and heart, lung, and kidney functions, are considered together with the potential effects of BS in reversing/reducing most of these unfavorable conditions [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…More uncertain are the consequences of BS on hospital admissions and healthcare resource use. Many studies reported lower hospital admissions after BS [ 11 , 12 , 13 , 14 , 15 ], suggesting beneficial effects on the chronic conditions characterizing individuals with obesity, such as type 2 diabetes mellitus, cardiovascular risk factors and diseases, chronic sub-clinic inflammation, and some types of cancer [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Other authors reported an increased request for inpatient and nonprimary outpatient care during the first 6-year period, but not thereafter in post-BS patients when compared to controls [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study

et al. 2021

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Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18–60 years, BMI ³ 40 kg/m2) admitted during 2002–2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95%CI 0.27–0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68–0.88 and HR = 0.78; 0.63–0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.

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Relation of Bariatric Surgery to Inpatient Cardiovascular Outcomes (from the National Inpatient Sample)

Cited by 19 publications

References 26 publications

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Obese Patients with Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study

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