30-day Major Adverse Cardiac Events (MACE) after elective bariatric surgery: the development and validation of the Bari-MACE clinical predictive tool.

BACKGROUND

Major adverse cardiac events (MACEs) after bariatric surgery are poorly understood yet are thought to be associated with significant morbidity and mortality.

OBJECTIVES

To evaluate the prevalence and clinical impact of short-term, 30-day MACE and to develop a pragmatic clinical predictive MACE scoring tool.

SETTING

This retrospective study was conducted using all the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited center data from 2015 to 2019.

METHODS

Primary Roux-en-Y and sleeve gastrectomy procedures were included, and prior revisional surgeries and emergency surgeries were excluded. Multivariable logistic regression modeling was used to examine the risk factors associated with 30-day MACE. Using forward regression, a Bari-MACE clinical prediction model was generated.

RESULTS

A total of 750,498 patients were included in our analysis of which 959 (.1%) experienced a MACE. MACE patients were older (54.0 ± 11.5 yr versus 44.4 ± 12.0 yr, P < .0001), and comprised a higher proportion of males (36.3% versus 20.4%, P < .0001) and patients of White racial status (74.0% versus 71.6%, P < .0001). The MACE cohort also had a higher body mass index (46.6 ± 9.7 kg/m versus 45.2 ± 7.8 kg/m, P < .0001), higher rates of sleep apnea (56.8% versus 38.2%, P < .0001), and a higher proportion of insulin-dependent diabetes (26.1% versus 8.4%, P < .0001) than non-MACE patients. Derivation of our clinical predictive Bari-MACE scoring model revealed 12 variables associated with development of MACE with a specificity of 97.8% using a 55-point threshold.

CONCLUSION

Thirty-day major adverse cardiac events after elective bariatric surgery are rare, occurring in approximately .1% of all patients, but are associated with significant morbidity and mortality. Using the MBSAQIP, we developed a Bari-MACE clinical predictive tool to risk-stratify patients with the aim to better guide perioperative care and foster improved surgical outcomes.