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Study identifies CP risk factors after surgery

Study could aid in the selection of patients who could have better outcomes

Low levels of high-density lipoprotein (HDL) cholesterol and high levels of C-reactive protein, age and BMI are significant predictors of cardiopulmonary (CP) complication following bariatric surgery, according to a study presented at the Digestive Disease Week conference, in Orlando, FL.

The study, ‘Predictors of Cardiopulmonary Complications Following Bariatric Surgery’, by researchers at Stanford University, CA, was undertaken to try and analyse the risk factors for cardiopulmonary complication for bariatric surgery.

A total of 1,634 patients who had one of three procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding, were included in the study over a ten year period.

Patient complications were analysed during a 90-day post-operative window and 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-operative biochemical cardiac risk values, demographics, and anthropometric features were collected prospectively and were matched to post-operative values to calculate percent change. Continuous variables were analysed by student t-test, with p-values ≤ 0.05 considered significant.

Results

The outcome showed that 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.

However, they 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.

The researchers concluded that the study clearly identifies factors that influence a patient's risk of cardiopulmonary complication after bariatric surgery and could assist in the selection of patients who could have better outcomes.

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