Outcomes of Cardiac Surgery in Patients with Prior Bariatric Surgery
Overview
This study analyzed cardiovascular surgery outcomes among patients with a history of metabolic and bariatric surgery (MBS) compared to eligible patients without MBS. Patients with prior MBS had significantly lower in-hospital mortality and fewer respiratory and infectious complications, particularly notable in those with class 3 obesity.
Background
Obesity contributes substantially to cardiovascular disease and related risk factors such as diabetes and hypertension. Metabolic and bariatric surgery (MBS) is the most effective treatment for durable weight loss but remains underutilized. While obesity's impact on cardiac surgery outcomes has been studied, the influence of prior MBS on these outcomes has not been well characterized. This study aimed to evaluate hospital morbidity and mortality after cardiovascular surgery in patients with and without a history of MBS.
Data Highlights
Outcome
MBS Group (%)
Non-MBS Group (%)
P Value
In-hospital mortality
0.9
1.7
0.03
Any complications
20
25
<0.001
Pneumonia
4.2
6.9
<0.001
Respiratory failure
8.4
11
0.003
Infectious complications
1.2
2.0
0.03
Key Findings
Patients with prior MBS had significantly lower in-hospital mortality (0.9% vs. 1.7%, P=0.03) after cardiovascular surgery compared to matched MBS-eligible patients without surgery.
MBS patients experienced fewer overall complications (20% vs. 25%, P<0.001), including pneumonia, respiratory failure, and infectious complications.
In subgroup analysis, patients with class 3 obesity and prior MBS had notably fewer pneumonia (2.6% vs. 7.6%, P<0.001) and infections (1.2% vs. 4.5%, P=0.003) than non-MBS counterparts.
Patients with MBS were more likely to undergo valve surgery and less likely to have coronary artery bypass grafting compared to those without MBS.
MBS patients had higher prevalence of autoimmune conditions, depression, hypothyroidism, and anemia, while non-MBS patients had higher rates of complicated diabetes and renal failure.
Clinical Implications
These findings suggest that prior metabolic and bariatric surgery may confer protective benefits during cardiovascular surgery, especially in patients with severe obesity. Clinicians should consider the potential improved surgical outcomes in patients with a history of MBS when planning cardiovascular interventions. Additionally, the reduced respiratory and infectious complications highlight the importance of weight management strategies in optimizing perioperative risk.
Conclusion
A history of metabolic and bariatric surgery is associated with lower in-hospital mortality and fewer complications following cardiovascular surgery, particularly among patients with class 3 obesity. These results support the role of MBS in improving surgical outcomes in obese patients undergoing cardiac procedures.
References
Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) 2016-2021
American Society for Metabolic and Bariatric Surgery Guidelines
