The population undergoing Bariatric Surgery (BaS) has many cardiovascular risk factors that can lead to significant perioperative cardiovascular morbidity. We aimed to examine trends in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) after BaS.
We performed a retrospective analysis of the MBSAQIP data registry for patients aged >=18 years old undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux en Y gastric bypass (LRYGB) during 2015-2019. Data on demographics, comorbidities and type of procedure was collected. MACCE was defined as a composite variable including perioperative acute myocardial infarction (AMI), cardiac arrest requiring cardiopulmonary resuscitation, acute stroke/cerebrovascular accident (CVA), and all-cause mortality. We utilized the Cochrane Armitage and Jonckheere-Terpstra tests to assess for significant trend changes throughout the years.
A total of 752,722 patients were included in our analysis (LSG=73.2%, LRYGB=26.8%). Postoperative MACCE occurred in 1,058 patients (0.14%), and was more frequent in patients undergoing LRYGB (0.20%). The frequency of MACCE declined from 0.17% to 0.14% (p=0.053), driven by a decline in the frequency of AMI (0.04 to 0.02%, p=0.002), cardiac arrest (0.05 to 0.04%, p=0.897) and all-cause death (0.11 to 0.08%, p=0.040), but with an increase in perioperative stroke/CVA (0.01 to 0.02%, p=0.057) (Figure 1). Significant changes in demographics, comorbidities and type of procedure are summarized in Table 1.
The overall risk of MACCE after BaS is 0.14% and has been declining in the last 5 years. This trend is likely multifactorial and further analysis is necessary to provide a detailed explanation.