Ascandar Nameer, Valenzuela Alberto Romo, Mabeza Russyan Mark, Mallick Saad, Charland Nicole C, Sanaiha Yas, Hadaya Joseph, Benharash Peyman
Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Surg Obes Relat Dis. 2024 Jan;20(1):1-7. doi: 10.1016/j.soard.2023.09.023. Epub 2023 Sep 28.
Superior clinical outcomes after hospitalization for cardiovascular-related disease such as acute heart failure have been linked with prior history of bariatric surgery, but similar analyses in acute myocardial infarction (MI) are currently limited.
This work examines clinical outcomes and resource utilization in patients with acute MI hospitalizations with a prior history of bariatric surgery.
Academic university-affiliated hospital in the United States.
All adult patients with hospitalizations with a primary diagnosis of acute MI were queried using the 2016-2020 Nationwide Readmissions Database. The study population was comprised of patients with an International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code for obesity (body mass index ≥35 kg/m) as well as those with a prior history of bariatric surgery regardless of their body mass index status. Comparison was made between those with a prior history of bariatric surgery and those without. Univariate analysis and multivariate regression models were used to examine the association between bariatric surgery and outcomes of interest, which included in-hospital mortality, medical complications, and resource utilization.
Of an estimated 2,736,606 hospitalizations for acute MI, 296,902 patients (10.8%) had a diagnosis of obesity and/or a prior history of bariatric surgery. The bariatric cohort was more frequently female and had a lower prevalence of congestive heart failure, chronic lung disease, diabetes, and electrolyte derangements than the nonbariatric cohort. After risk adjustment, prior history of bariatric surgery was associated with significantly lower odds of in-hospital mortality, cardiogenic shock, and acute kidney injury. Additionally, prior history of bariatric surgery was linked to a decreased duration of hospital stay and lower hospitalization costs as well as lower odds of nonhome discharge.
Among acute MI patients with obesity, prior history of bariatric surgery was associated with decreased odds of in-hospital mortality, improved clinical outcomes, and lower resource utilization. Expansion of bariatric surgery programs may provide improved access to a medical intervention that is intertwined with cardiovascular health.
诸如急性心力衰竭等心血管相关疾病住院后的卓越临床结局与既往减肥手术史有关，但目前急性心肌梗死（MI）方面的类似分析有限。
本研究探讨有既往减肥手术史的急性MI住院患者的临床结局和资源利用情况。
美国一所大学附属医院。
使用2016 - 2020年全国再入院数据库查询所有以急性MI为主要诊断住院的成年患者。研究人群包括国际疾病分类第十版（ICD - 10）肥胖诊断代码（体重指数≥35 kg/m²）的患者以及有既往减肥手术史的患者，无论其体重指数状况如何。对有既往减肥手术史的患者和无此病史的患者进行比较。采用单因素分析和多因素回归模型来研究减肥手术与感兴趣的结局之间的关联，这些结局包括住院死亡率、医疗并发症和资源利用。
在估计的2736606例急性MI住院患者中，296902例患者（10.8%）诊断为肥胖和/或有既往减肥手术史。减肥手术队列中女性更为常见，与非减肥手术队列相比，充血性心力衰竭、慢性肺病、糖尿病和电解质紊乱的患病率较低。经过风险调整后，既往减肥手术史与住院死亡率、心源性休克和急性肾损伤的显著较低几率相关。此外，既往减肥手术史与住院时间缩短、住院费用降低以及非回家出院几率降低有关。
在肥胖的急性MI患者中，既往减肥手术史与住院死亡率降低、临床结局改善和资源利用减少有关。扩大减肥手术项目可能会改善获得与心血管健康相关的医疗干预的机会。
