Benefits of bariatric surgery in patients with acute ischemic stroke-a national population-based study.

BACKGROUND

To explore the effects of prior bariatric surgery (prior BS) on clinical outcomes in hospitalized patients with acute ischemic stroke (AIS).

SETTING

Inpatient hospital admissions from the Nationwide Inpatient Sample.

METHODS

We identified hospitalized patients with a primary diagnosis of AIS between 2006 and 2014. The primary endpoint was in-hospital mortality. Secondary endpoints included disability status, poststroke complications, and healthcare utilization indicators, including length of hospital stay and total cost. Multivariate regression analyses were performed after adjusting for potential confounders to compare outcomes between patients with prior BS and those with morbid obesity.

RESULTS

Of 24,534 (weighted 121,578) patients with AIS, 1654 (weighted 8154) reported a history of BS, and the rest were diagnosed with morbid obesity. Rates of prior BS and morbid obesity in AIS have significantly increased over the study period. Patients with prior BS were younger and more likely to be white, female, with fewer co-morbidities and poststroke complications, and higher rates of thrombolysis treatment. Multivariate regression analyses revealed that prior BS with body mass index <35 kg/m was associated with lower mortality (odds ratio [OR] .58, 95% confidence interval [CI] .37-.90), lower odds of moderate-to-severe disability (OR .64, 95% CI .56-.73), acute respiratory failure (OR .63, 95%CI .45-.87), sepsis (OR .50, 95% CI .26-.96), acute kidney failure (OR .67, 95% CI .52-.87), 13% shorter hospitalization, and 6% lower total hospital costs.

CONCLUSIONS

Among hospitalized patients with AIS, prior BS with body mass index <35 kg/m is associated with lower in-hospital mortality, fewer poststroke complications, improved disability status, and better healthcare utilization.