Key result
Prior bariatric surgery was associated with a significantly reduced risk of major perioperative adverse cardiovascular and cerebrovascular events (OR 0.71) compared to morbid obesity in patients with type 2 diabetes undergoing noncardiac surgery.
Why the study?
Both diabetes and obesity are risk factors for perioperative major adverse events, but the association between prior bariatric surgery and perioperative cardiovascular outcomes after noncardiac surgery in patients with T2DM remained to be evaluated.
Does prior bariatric surgery reduce the risk of perioperative major adverse cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus undergoing noncardiac surgery?
Cohort (n=1,526,820)
Yes
Does prior bariatric surgery reduce the risk of perioperative major adverse cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus undergoing noncardiac surgery?
Odds Ratio: 0.71 (95% CI 0.62–0.81)
Absolute Event Rate: 1.01% vs 3.25%
p-value: p=<0.0001
Prior bariatric surgery is associated with a significantly lower risk of major perioperative adverse cardiovascular and cerebrovascular events in patients with type 2 diabetes undergoing noncardiac surgery.
May inform perioperative risk stratification in T2DM; leaves open causal confirmation and practice change.
BACKGROUND: Both diabetes and obesity are risk factors for perioperative major adverse events. This study aims to evaluate the association between prior bariatric surgery (prior-BS) and perioperative cardiovascular outcomes following noncardiac surgery in patients with type 2 diabetes mellitus (T2DM). METHODS: We used the National Inpatient Sample Database to identify T2DM patients undergoing major noncardiac surgery from 2006 to 2014. The primary outcome was major perioperative adverse cardiovascular and cerebrovascular events (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. RESULTS: A weighted of 1,526,820 patients diagnosed with T2DM who underwent noncardiac surgery were included. The rates of both prior BS and morbid obesity significantly increased during the study period (P < 0.0001). Patients with prior BS were younger, were more likely to be female, and had lower rates of cardiovascular risk factors but had higher rates of smoking, alcohol abuse, anaemia, prior venous thromboembolism and prior percutaneous coronary intervention. The incidence of MACCEs was 1.01% and 3.25% in patients with prior BS and morbid obesity, respectively. After multivariable adjustment, we found that prior BS was associated with a reduced risk of MACCEs (odds ratio [OR] = 0.71; 95% confidence interval [CI] 0.62-0.81), death (OR = 0.64, 95% CI 0.52-0.78), 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). CONCLUSIONS: Prior bariatric surgery in T2DM patients undergoing noncardiac surgery is associated with a lower risk of MACCEs. Prospective studies are needed to verify the benefits of bariatric surgery in patients undergoing noncardiac surgery.
No takes yet. Share an insight, caveat, or question.
Jin et al. (2020) conducted a cohort in Type 2 diabetes mellitus undergoing major noncardiac surgery (n=1,526,820). Prior bariatric surgery vs. Morbid obesity was evaluated on Major perioperative adverse cardiovascular and cerebrovascular events (MACCEs) (OR 0.71, 95% CI 0.62-0.81, p=<0.0001). Prior bariatric surgery was associated with a significantly reduced risk of major perioperative adverse cardiovascular and cerebrovascular events (OR 0.71) compared to morbid obesity in patients with type 2 diabetes undergoing noncardiac surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: