Outcomes of cardiac arrest hospitalizations in patients with obesity with versus without prior bariatric surgery status:A nationwide propensity-matched analysis

Rupak Desai; Zainab Gandhi; Abhimanyu Ravalani; Kamran Mahfooz; Uvesh Mansuri; Akhil Jain; Ankit Vyas; Rajeev Gupta; Carl J Lavie

doi:10.1016/j.ijcrp.2023.200235

Outcomes of cardiac arrest hospitalizations in patients with obesity with versus without prior bariatric surgery status:A nationwide propensity-matched analysis

Int J Cardiol Cardiovasc Risk Prev. 2023 Dec 22:20:200235. doi: 10.1016/j.ijcrp.2023.200235. eCollection 2024 Mar.

Authors

Rupak Desai¹, Zainab Gandhi², Abhimanyu Ravalani³, Kamran Mahfooz⁴, Uvesh Mansuri⁵, Akhil Jain⁶, Ankit Vyas⁷, Rajeev Gupta⁸, Carl J Lavie⁹

Affiliations

¹ Independent Researcher, Atlanta, GA, USA.
² Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA, USA.
³ Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA.
⁴ Department of Internal Medicine, Lincoln Medical Center, New York, NY, USA.
⁵ Department of Internal Medicine, Medstar Harbor hospital, Baltimore, MD, USA.
⁶ Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA, USA.
⁷ Division of Vascular Medicine, Ochsner Health, New Orleans, LA, USA.
⁸ Consultant Cardiologist, Spectrum Medical Center and Burjeel Royal Hospital, Al Ain, United Arab Emirates.
⁹ John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.

Abstract

Introduction: Prior bariatric surgery (PBS) status in obese patients is thought to curtail the risk of cardiovascular events, but its role in change of outcomes of patients with obesity developing new acute cardiac events such as cardiac arrests (CA) remains largely unknown.

Methods: Hospitalizations among adult patients with obesity and CA were identified retrospectively using the National Inpatient Sample (2015 October-2017 December). Propensity-matched analysis (1:1) was performed for sociodemographic/hospital characteristics to identify two cohorts, with (PBS+) or without (PBS-) status. The primary endpoint was in-hospital mortality, and the secondary endpoint was healthcare resource utilization.

Results: Both cohorts (n = 1275 each), had patients with comparable age (mean 58 years), with a higher frequency of white (>70 %), females (>60 %), and Medicare enrollees (>40 %). PBS + cohort had lower rates of diabetes (27.8 % vs 36.1 %), hyperlipidemia (33.7 % vs 48.6 %), renal failure (17.3 % vs 22.0 %), chronic pulmonary disease (11.8 % vs 21.2 %) and higher rates of anemias (18.4 % vs 12.2 %), liver disease (5.1 % vs 2.4 %) and alcohol abuse (6.7 % vs 2.4 %) than PBS- cohort (p < 0.05). All-cause mortality (46.3 % vs 45.1 %, p = 0.551) was comparable between the two cohorts. The PBS + cohort was less often transferred routinely (p<0.001) but had a shorter hospital stay (p<0.001) with equivalent hospital charges compared to the PBS- cohort.

Conclusions: The PBS status (regardless of chronology) did not increase survival in CA admissions among patients with obesity. Preventive measures are necessary to manage enduring cardiovascular disease risk factors that may limit the advantages of surgery for patients with obesity and aggravate the worse outcomes of future cardiac events.

Keywords: Bariatric surgery; Cardiac arrest; Mortality; Obesity/obese; Weight loss surgery.