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Prior bariatric surgery T2DM patients have reduced risk of MACCEs undergoing noncardiac surgery

Thu, 07/09/2020 - 09:06
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Prior bariatric surgery (prior-BS) in type 2 diabetes mellitus (T2DM) patients undergoing noncardiac surgery is associated with a lower risk of major adverse cardiovascular and cerebrovascular events (MACCEs), according to researchers from The First Affiliated Hospital, Sun Yat-Sen University, South China University of Technology, Guangzhou and the Second Military Medical University, Shanghai, China.

The authors noted that evidence from the National Inpatient Sample (NIS) of patients aged 45 years who underwent noncardiac surgery showed an unfavourable trend of perioperative MACCEs among subjects with T2DM versus those without T2DM. However, the trend of perioperative MACCEs among patients with T2DM and morbid obesity and the influence of bariatric surgery on MACCEs have not been examined

In the study, ‘Prior bariatric surgery and perioperative cardiovascular outcomes following noncardiac surgery in patients with type 2 diabetes mellitus: hint from National Inpatient Sample Database’, published in Cardiovascular Diabetology, the investigators compared the perioperative cardiovascular outcomes after noncardiac surgery among prior-BS T2DM patients and those with morbid obesity.

They used the National Inpatient Sample Database to identify T2DM patients undergoing major noncardiac surgery from 2006 to 2014. The primary outcome MACCEs, which include death, acute myocardial infarction and acute ischaemic stroke. In-hospital outcomes between patients with prior BS and morbid obesity were compared using unadjusted logistic, multivariable logistic and propensity score matching analyses.

Outcomes

From 2006 to 2014, an estimated 1,526,820 adults hospitalised for major noncardiac surgery were identified as T2DM patients, among whom 119,002 (7.79%) were diagnosed with prior-BS and 1,407,818 (92.21%) were diagnosed with morbid obesity. The proportion of morbid obesity in T2DM patients undergoing noncardiac surgery increased significantly over time (7.42% in 2006 to 17.08% in 2014, p<0.0001). Additionally, the proportion of patients with prior-BS also increased significantly over time (0.11% in 2006 to 1.55% in 2014, p<0.0001). The rates of prior-BS and morbid obesity were compared among nine categories of surgery: patients who underwent general surgery had the highest rates for both prior-BS and morbid obesity (1.82% and 24.42%, respectively), followed by skin/breast surgery (1.22% and 13.53%, respectively).

Patients with prior-BS tended to be younger, female, and white; have lower rates of cardiovascular risk factors (such as dyslipidaemia, hypertension and coronary artery disease); and have better control of diabetes and lower rate of diabetes-related complications. However, patients with prior-BS had higher rates of smoking, alcohol abuse and drug abuse. These patients were also more likely to have undergone orthopaedic surgery and less likely to have undergone general surgery.

The rate of perioperative MACCEs was approximately 1.0% and did not change significantly over time (0.68% to 1.11%, p= 0.0725) among patients with prior-BS, while the rate increased significantly from 1.15 to 2.04% among patients with morbid obesity (p<0.0001). Regarding perioperative death, the rate declined significantly from 0.85% in 2006 to 0.33% in 2014 (p<0.0001) among patients with prior-BS, compared with patients with morbid obesity rates of perioperative death that increased significantly over time (0.56% in 2006 to 0.95% in 2014, p<0.0001).

The rate of perioperative acute ischemic stroke increased among both patients with prior-BS (0.32% to 0.43%, p<0.0001) and those with morbid obesity (0.23% to 0.59%, p<0.0001). The rate of perioperative acute myocardial infarction increased among both patients with prior-BS (0.00% to 0.36%, p<0.0001) and those with morbid obesity (0.44% to 0.66%, p<0.0001).

MACCEs occurred in 1,210 (1.01%) major noncardiac surgeries among patients with prior BS, compared with 46,225 (3.25%) among patients with morbid obesity (p<0.0001). Unadjusted analysis suggested that prior-BS was associated with a reduced risk of all perioperative outcomes. After multivariable adjustment, they reported that prior-BS was associated with a reduced risk of MACCEs (OR = 0.71; 95% confidence interval [CI] 0.62–0.81), death (OR = 0.64, 95% CI 0.52–0.78), AMI (OR = 0.71, 95% CI 0.57–0.89), acute kidney injury (OR = 0.66, 95% CI 0.62–0.70) and acute respiratory failure (OR: 0.46; 95% CI 0.42–0.50).

“Bariatric surgery is a promising treatment for obese T2DM patients and not only provides better glycaemic control and sustained weight loss but also reduces the risk of cardiovascular disease and MACCEs in individuals undergoing noncardiac surgery,” the authors concluded. “Since the current study was observational, prospective studies are needed to verify the benefits of bariatric surgery in noncardiac surgery patients.”

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