SSAT - Do CVD Patients Undergoing Bariatric Surgery Have Similar Outcomes to Non-CVD Patients?

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Do CVD Patients Undergoing Bariatric Surgery Have Similar Outcomes to Non-CVD Patients?
Lindsey Voller^*, Sayantan Deb, Wes Turner, Chase Palisch, Michaela Derby, Kaci Dudley, Dan Azagury, Homero Rivas, John M. Morton
General Surgery, Stanford University, Stanford, CA

BACKGROUND: Obesity is one of the leading causes of morbidity and mortality in the U.S., with associated systemic effects such as cardiovascular disease (CVD). Bariatric surgery has been shown to improve many aspects of CVD, yet few studies have explored the influence of preoperative CVD on postoperative bariatric outcomes.
METHODS: This retrospective study included 89 individuals with CVD and 1,029 individuals with no history of CVD undergoing bariatric surgery at a single academic institution between 2010 and 2014. Preoperative CVD was defined as any heart condition prior to surgery, including the following heart diseases: congestive heart failure (33.7%), prior myocardial infarction (21.3%), and cardiomyopathy (11.2%); vasculopathies: coronary artery disease (28.1%), cerebrovascular accidents (5.6%), and other (6.7%); and cardiac arrhythmias: LBBB (4.5%), atrial fibrillation (3.4%), and other (6.7%). Demographic and anthropometric data were collected preoperatively and at 3, 6, and 12 months after surgery, along with body mass index (BMI), percentage of excess weight loss (%EWL), and levels of cardiac biomarkers. Postoperative rates of complications and readmissions were also obtained from patient charts. Student’s T-test and Fisher’s exact test (or their non-parametric equivalents) were used to analyze continuous and dichotomous variables respectively using GraphPad version 6.01.
RESULTS: The study cohort with prior CVD had a significantly higher mean age (54.4 vs. 45.4 years, p<.0001), larger waist circumference (137.2 vs. 131.3cm, p=.0036), and lower proportion of females (55.1 vs. 79.6%, p<.0001) than the cohort with no known heart conditions. Both groups demonstrated significant weight loss at all postoperative time points, with no significant differences in %EWL between the two groups (all p>.05): CVD cohort 3mos: 38.5%, 6mos: 53.0%, 12mos: 60.6%; non-CVD cohort 3mos: 40.4%, 6mos: 56.3%, 12mos: 65.6%. Similarly, there were no significant differences in postoperative BMI or improvement in levels of cardiac biomarkers between the two cohorts at any time point. However, patients with preoperative CVD had higher rates of 30-day complications (14.6 vs. 4.8%, p=.0007) and readmissions (9.0 vs. 3.8%, p=.0278) as compared to controls, with 38.5% of readmissions related to excess bleeding.
CONCLUSION: This study demonstrates the continuous benefit of bariatric surgery to reduce weight and improve cardiac function irrespective of preoperative cardiovascular disease. Importantly, bariatric providers should closely follow up with patients on anti-platelet/anticoagulation therapy for CVD in order to reduce risks of postoperative complications and readmissions.

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