What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Obesity (n=2125741). Intervention: Bariatric surgery vs. Non-surgical care. Primary outcome: Risk of stroke (HR 0.71, 95% CI 0.65-0.77, p=<0.0001).

May 11, 2026The Egyptian Journal of Neurology Psychiatry and Neurosurgery0 citationsOpen Access

Risk of stroke after bariatric surgery: a systematic review, meta-analysis and meta-regression

Q: What are the key findings of this study?

Bariatric surgery was associated with a 29% lower risk of stroke compared with non-surgical care in patients with obesity (HR 0.71).

HMHasan MatarJordan University of Science and Technology DRDanya Al RadaidehYarmouk University SBSaed O. BanatYarmouk University

Key Result

Bariatric surgery was associated with a 29% lower risk of stroke compared with non-surgical care in patients with obesity (HR 0.71).

Study Design

Type

Meta-Analysis (n=2,125,741)

Multicenter

Yes

Structured PICO

Does bariatric surgery reduce stroke incidence in patients with obesity?

Population

2,125,741 patients with obesity across 18 cohort studies (pooled analysis of 16 studies with 975,351 patients)

Intervention

Bariatric surgery

Comparator

Non-surgical care

Outcome

Stroke incidencehard clinical

Bariatric surgery is associated with a significantly reduced long-term risk of stroke in patients with obesity compared to non-surgical management.

Main Result

Effect estimate: HR 0.71 (95% CI 0.65-0.77)

p-value: p=<0.0001

Limitations

Residual confounding may still exist because the majority of the included studies were observational.
Moderate heterogeneity (I2 ≈ 60%) across the included studies.
Unable to perform detailed stratified analyses according to specific bariatric procedures, control group characteristics, or baseline comorbidities.
Possible small-study effects indicated by slight asymmetry in the funnel plot.

Abstract

Abstract Background Obesity is a major global health challenge, strongly associated with diabetes, hypertension, and cardiovascular disease, all of which increase stroke risk. Bariatric surgery is among the most effective treatments for severe obesity, leading to significant and sustained weight loss and improvements in metabolic health. However, its long-term impact on cerebrovascular outcomes remains unclear. Methods We searched multiple databases for cohort studies that compared stroke incidence in patients undergoing bariatric surgery. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was quantified using the I 2 statistic. Meta-regression was performed to explore the effects of age, BMI and follow-up duration. Results Eighteen studies comprising 2,125,741 patients were included. Pooled analysis of 16 studies (975,351 patients) showed that bariatric surgery was associated with a 29% lower risk of stroke compared with non-surgical care (HR = 0.71, 95% CI 0.65–0.77, p < 0.0001). Heterogeneity was moderate (I 2 = 60.6%) but resolved in sensitivity analyses. No significant publication bias was detected and meta-regression showed no effect modification by age, BMI or follow-up duration. Conclusion This meta-analysis provided a robust evidence that bariatric surgery is associated with a significantly reduced risk of stroke in patients with obesity. The findings highlight bariatric surgery not only as an effective intervention for weight loss and metabolic improvement but also as a meaningful strategy for long-term cerebrovascular risk reduction. Incorporating bariatric surgery into comprehensive cardiovascular and stroke prevention strategies could have substantial public health impact.

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