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Introduction
Bariatric surgery provides effective and enduring weight loss as well as resolution of comorbid disease. Many bariatric patients suffer from cardiopulmonary conditions prior to surgery and receive relief from these comorbidities following surgery. However; little is known about what predicts cardiopulmonary complications in these already at risk patients. This study analyzes risk factors for cardiopulmonary complication for bariatric surgery.
Methods
Over a 10-year period at a single academic institution, 1634 patients underwent one of three procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. Complications were analyzed during a 90-day post-operative window. Cardiopulmonary complications included DVT/PE, myocardial infarction, arrhythmia, and cerebrovascular accident. Non-cardiopulmonary complications included anastomotic leak / intra-abdominal abscess, bowel obstruction, pneumonia, bleeding, and ulcer / stricture. Pre-op biochemical cardiac risk values, demographics, and anthropometric features were collected prospectively Pre-op biochemical risk factors were matched to post-operative values to calculate percent change. Continuous variables were analyzed by student t-test. P-values ≤ 0.05 were considered significant. All analyses were performed using Stata/SE statistica software, release 12.
Results
Of 12 preoperative characteristics included in the regression model, HDL ≤ 40 (OR 2.40, 95% CI (1.11 - 5.19)), high-sensitivity C-reactive protein ≥ 11 (OR 2.22, 95% CI (1.05 - 4.67)), Age ≥ 50 (OR 2.72, 95% CI (1.31 - 5.63)), and BMI ≥ 50 (OR 2.31, 95% CI (1.12 - 4.76)) were found to be significant predictors of cardiopulmonary complication. Furthermore, these features were not found to be significant predictors of non-cardiopulmonary complication. At 12 months after surgery, those experiencing a cardiopulmonary complication had a 9% improvement in HDL compared to 23% improvements in those experiencing a non-cardiopulmonary complication or no complication at all. Individual t-tests comparing cardiopulmonary complication to non-cardiopulmonary complication and no complication were all significant. A logistic regression was used to show that incidence of a cardiopulmonary complication, baseline HDL ≤40, age ≥ 50, and BMI ≥ 50 are all individual predictors for a negative percent change in HDL at 12 months.
Conclusion
HDL, hs-C-reactive protein, age, and BMI were all found to be significant predictors of cardiopulmonary complication. HDL, which is cardio-protective, showed reduced post-op improvement in patients with cardiopulmonary complications at 1 year. This study clearly identifies factors that influence a patient's risk of cardiopulmonary complication after bariatric surgery.