Prior bariatric surgery is independently and significantly associated with a 36% lowered risk for any life-threatening morbidity and a 57% reduced risk for prolonged length of hospital stay (LOS) in patients hospitalised for acute allergic reaction and anaphylaxis, compared to those who did not undergo prior bariatric surgery, according to researchers from Fu Jen Catholic University, New Taipei City, Taiwan.
The researcher stated that acute allergic reactions may occur in susceptible individuals following exposure to various allergens. In addition, obesity is linked to allergic reactions and weight loss from bariatric surgery may reduce the severity of certain conditions such as airway hyperresponsiveness in asthma.
To investigate whether there is an association between prior bariatric surgery and lower risk for life-threatening conditions in patients hospitalised with acute allergic reactions and anaphylaxis, the researchers used data from the US Nationwide Inpatient Sample (NIS) database 2005–2018. All adults diagnosed with morbid obesity and admitted to US hospitals with acute allergic reactions/anaphylaxis were included (n=21,561). After excluding patients without information on in-hospital mortality, discharge destination, hospital costs and LOS, 21126 patients were divided into two groups based on prior bariatric surgery or not. Among these, 683 patients had undergone bariatric surgery, and 2,732 patients were not retained for subsequent analyses after 1:4 ratio PSM.
The mean age of the Patients’ mean age was 54.7±0.1 years and 67.5% were female. Significant differences were found between patients with or without prior bariatric surgery in age, sex, race, income, primary payer, some comorbidities and hospital location 67.5%. Patients with prior bariatric surgery were younger, with more females, and had fewer comorbidities than those without bariatric surgery. After PSM, the different initial distributions in the characteristics of patients and hospital between the two groups were similar.
Outcomes
After matching, patients with prior bariatric surgery had a significantly lower proportion of any life-threatening morbidity (37.2% vs 47.4%), respiratory distress and failure (11.2% vs 17.0%), pneumonia and severe infection (7.4% vs 10.2%), sepsis and septic shock (15.2% vs 20.9%), intubation and mechanical ventilation (11.2% vs 14.6%), prolonged LOS (10.3% vs 20.6%) and unfavourable discharge (6.9% vs 12.5%) than those without prior bariatric surgery, respectively.
A multivariable regression model to determine the associations between inpatient outcomes and prior bariatric surgery (after adjusting for relevant confounders) revealed that patients who had prior bariatric surgery were significantly less likely to have life-threatening morbidity during hospitalization than those who had not. In addition, patients with prior bariatric surgery had a significantly lower risk for prolonged LOS. However, prior bariatric surgery was not associated with reduced odds of significant mortality or unfavourable discharge. Regarding individual morbidities, significantly lower odds were found in respiratory distress and failure, pneumonia and severe infection, sepsis and septic shock, and intubation and mechanical ventilation in patients with prior bariatric surgery compared to those without prior bariatric surgery.
“Although results of the present study indicate that patients with prior bariatric surgery are less likely to have life-threatening morbidity and prolonged LOS, the mechanism underlying the protective effect of bariatric surgery on outcomes of hospitalisation for acute allergic reaction is unclear,” the authors noted.
The researchers called for further prospective studies incorporating measurements of exact weight loss following bariatric surgery to substantiate their findings and investigate the underlying mechanisms that elucidate the beneficial effects bariatric surgery within this patient population.
The findings were reported in the paper, ‘Prior Bariatric Surgery Predicts Lower Life-Threatening Morbidity in Patients Admitted for Acute Allergic Reaction and Anaphylaxis: a Propensity Score-Matched Analysis of the U.S. Nationwide Inpatient Sample, 2005–2018’, published in the journal Obesity Surgery. To access this paper, please click here
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