Hospitalisations for recurrent stroke decreased over time in patients who had undergone bariatric surgery compared to those who had not, suggesting that bariatric surgery is a viable intervention to lower stroke recurrence risk in this population, according to the outcomes from a study by a team of international researchers.
The study investigators conducted a study using the National Inpatient Sample (NIS) from 2016 to 2019 and identified the population of hospitalisations of older individuals (aged 65 and above) who have obesity, a history of diagnosed stroke and a history of bariatric surgery or not.
In total, there were 643,505 hospitalisations of older individuals ( ≥ 65 years) with obesity who also had a prior history of stroke. Of those, 11,820 (1.8 %) hospitalised patients had a prior bariatric surgery (PBS) history. From the overall population cohort, 27,430 patient hospitalisations occurred for acute ischemic stroke events, and of those, 395 (1.4 %) of those had a history of PBS.
Age distribution differed significantly between groups, with a median age of 74 years in the non-PBS cohort and 70 years in the PBS cohort (p<0.001). Sex distribution also varied significantly with the non-PBS group comprised of 40.28 % males and 59.72% females, whereas the PBS group included 26.27 % males and 73.73 % females (p<0.001). Racial composition showed that the PBS group had a higher percentage of White individuals (83.81 %) than the non-PBS group (76.46 %).
Conversely, the proportions of Black, Hispanic, Asian or Pacific Islander, and Native American individuals were lower in the PBS group vs the non-PBS group (p<0.001). Medicare was the predominant insurance type in both PBS (90.74 %) and non-PBS (91.71 %). Additionally, the proportion of Medicaid use was significantly lower in the PBS group (0.51 % vs. 1.32 %).
There were no significant differences in the prevalence of hypertension between groups despite it being most prevalent (83.21 % vs. 83.59 %, p=0.259). Significant differences were observed in the prevalence of hyperlipidaemia (61.59 % vs. 68.20 %, p<0.001), diabetes mellitus (52.24 % vs. 60.05 %, p<0.001), prior myocardial infarction (12.82 % vs. 15.72 %, p<0.001), peripheral vascular disease (8.84 % vs. 11.87 %, p<0.001), with these comorbidities being more prevalent in the non-PBS group. Additionally, smoking (37.48 % vs. 36.39 %, p=0.014), valvular disease (3.89 % vs. 3.55 %, p=0.044) and drug abuse (1.61 % vs. 1.08 %, p<0.001) were more prevalent in the PBS group.
The unadjusted analysis showed that those with PBS had decreased odds of having recurrent acute ischemic stroke hospitalization by 23 % (OR: 0.77 [95 % C.I. 0.69–0.86]). After adjusting for all baseline demographics and comorbidities, the association remained significant (aOR: 0.77 [95 % C.I. 0.60–0.98]), suggesting that bariatric surgery may be protective against this outcome even when considering other influencing factors.
The trends of patient hospitalisations for recurrent acute ischemic stroke events without PBS showed 4.4 % in 2016, 4.2 % in 2017, 4.3 % in 2018 and 4.2 % in 2019 (p=0.064). However, patients with recurrent stroke hospitalisations with a history of PBS were 4 % in 2016, 3.3 % in 2017, 3.4 % in 2018 and 2.9 % in 2019 (p=0.035, Figure 1).
“Our findings present compelling evidence that bariatric surgery may serve as a significant protective measure against hospitalizations for the recurrence of acute ischemic strokes in older individuals with obesity with a history of stroke by 23%,” the authors noted. “The reduced odds remain significant even after adjustment for age, gender, race, income and comorbidities.”
The findings were reported in the paper, ‘Bariatric surgery association with risk of recurrent stroke hospitalization among older stroke survivors with obesity: A national inpatient sample study (2016–2019)’, published in Obesity Pillars. To access this paper, please click here
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