Department of Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana; Department of Surgery, Metamor Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Department of Behavioral & Community Health, Louisiana State University School of Public Health, New Orleans, Louisiana.
Surg Obes Relat Dis. 2023 Jan;19(1):59-67. doi: 10.1016/j.soard.2022.08.014. Epub 2022 Sep 6.
Recent examination of trends in postoperative major adverse cardiovascular and cerebrovascular events (MACE) following bariatric surgery, including accredited and nonaccredited centers, and the factors affecting those trends, is lacking.
The objective of this study was to evaluate current trends for postoperative MACE after bariatric surgery in both accredited and nonaccredited centers and the factors affecting these trends.
This retrospective study was conducted using National Inpatient Sample database from 2012 to 2019.
All patients who underwent inpatient laparoscopic sleeve gastrectomy (LSG), open sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and open Roux-en-Y gastric bypass (RYGB) were examined. Composite MACE (acute myocardial infarction, cardiac arrest, acute stroke, and in-hospital death during bariatric surgery hospitalization) was calculated and analyzed over time along with patient demographic and co-morbid diseases using survey-weighted logistic regression.
MACE incidence was lowest for LSG (0.07%), followed by LRYGB (0.16%), SG (3.47%), and RYBG (3.51%). Open procedure, increasing age, male sex, body mass index ≥50, coronary artery disease, congestive heart failure, and chronic kidney disease were independent predictors for increased MACE risk. MACE incidence increased over time for SG (odds ratio [OR] 1.25 [1.16, 1.34]; P < .0001) and RYGB (OR 1.14 [1.06, 1.22]; P = .0004) but decreased for LRYGB (OR 0.93 [0.87, 1] P = .06). After adjustment for high-risk covariates, increased MACE trend seen over time was attenuated in SG (OR 1.13 [1.04-1.22]; P = .005) and RYGB (OR 1.04 [0.96-1.12]; P = .36), while there was minimal effect of these high-risk covariates on MACE trend over time in LSG and LRYGB.
MACE following LSG and LRYGB is rare, occurring in 0.1% of patients. Persistently increasing high-risk conditions and demographics has had minimal effect on MACE over time for LSG and LRYGB but has had significant effect on MACE trend over time in SG and RYGB.
最近检查了肥胖症手术后主要不良心脑血管事件（MACE）的趋势，包括认证和非认证中心，以及影响这些趋势的因素，但缺乏对此的研究。
本研究旨在评估认证和非认证中心肥胖症手术后的 MACE 术后趋势以及影响这些趋势的因素。
本回顾性研究使用了 2012 年至 2019 年的国家住院患者样本数据库。
所有接受住院腹腔镜袖状胃切除术（LSG）、开放式袖状胃切除术（SG）、腹腔镜 Roux-en-Y 胃旁路术（LRYGB）和开放式 Roux-en-Y 胃旁路术（RYGB）的患者均接受了检查。使用调查加权逻辑回归，随时间计算和分析复合 MACE（肥胖症手术住院期间急性心肌梗死、心脏骤停、急性中风和院内死亡）以及患者人口统计学和合并症。
LSG 的 MACE 发生率最低（0.07%），其次是 LRYGB（0.16%）、SG（3.47%）和 RYBG（3.51%）。开放式手术、年龄增长、男性、体重指数≥50、冠心病、充血性心力衰竭和慢性肾脏病是 MACE 风险增加的独立预测因素。SG（优势比[OR]1.25[1.16,1.34]；P<.0001）和 RYGB（OR 1.14[1.06,1.22]；P=.0004）的 MACE 发生率随时间增加，但 LRYGB 的 MACE 发生率随时间降低（OR 0.93[0.87,1]；P=.06）。在调整高危协变量后，SG（OR 1.13[1.04-1.22]；P=.005）和 RYGB（OR 1.04[0.96-1.12]；P=.36）中随时间推移的 MACE 趋势有所减弱，而 LSG 和 LRYGB 中这些高危协变量对 MACE 趋势随时间推移的影响较小。
LSG 和 LRYGB 后的 MACE 罕见，发生率为 0.1%。持续增加的高危情况和人口统计学特征对 LSG 和 LRYGB 的 MACE 随时间推移的影响最小，但对 SG 和 RYGB 的 MACE 趋势随时间推移的影响显著。
