Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Surg Obes Relat Dis. 2022 Mar;18(3):357-364. doi: 10.1016/j.soard.2021.12.008. Epub 2021 Dec 10.
Major adverse cardiac events (MACEs) after bariatric surgery are poorly understood yet are thought to be associated with significant morbidity and mortality.
To evaluate the prevalence and clinical impact of short-term, 30-day MACE and to develop a pragmatic clinical predictive MACE scoring tool.
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.
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.
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.
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.
减重手术后的主要不良心脏事件（MACE）了解甚少，但据认为与重大发病率和死亡率相关。
评估短期（30 天）MACE 的患病率和临床影响，并制定实用的临床预测 MACE 评分工具。
这项回顾性研究使用了 2015 年至 2019 年所有经代谢和减重手术认证和质量改进计划（MBSAQIP）认可中心的数据。
纳入原发性 Roux-en-Y 和袖状胃切除术，排除先前的修正手术和急诊手术。使用多元逻辑回归模型检查与 30 天 MACE 相关的风险因素。使用正向回归生成 Bari-MACE 临床预测模型。
我们的分析共纳入了 750498 例患者，其中 959 例（0.1%）发生了 MACE。MACE 患者年龄较大（54.0±11.5 岁比 44.4±12.0 岁，P<.0001），且男性比例较高（36.3%比 20.4%，P<.0001）和白种人比例较高（74.0%比 71.6%，P<.0001）。MACE 组的体重指数（46.6±9.7 kg/m 比 45.2±7.8 kg/m，P<.0001）更高，睡眠呼吸暂停发生率（56.8%比 38.2%，P<.0001）更高，胰岛素依赖型糖尿病比例（26.1%比 8.4%，P<.0001）也更高。我们的临床预测 Bari-MACE 评分模型的推导表明，有 12 个变量与 MACE 的发生相关，使用 55 分阈值的特异性为 97.8%。
择期减重手术后 30 天内发生的主要不良心脏事件很少见，约占所有患者的 0.1%，但与重大发病率和死亡率相关。使用 MBSAQIP，我们开发了 Bari-MACE 临床预测工具，以对患者进行风险分层，旨在更好地指导围手术期护理并促进手术结果的改善。
