Machado Carvalhais Ricardo, Siochi Christian, Harutyunyan Gohar, Segura Torres Danny, Shahmoradi Vahe, Sobieraj Peter, Canuto Miller Aressa, Jesmajian Stephen
Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA.
Cureus. 2024 Jun 13;16(6):e62284. doi: 10.7759/cureus.62284. eCollection 2024 Jun.
The "obesity paradox" claims that although obesity is a risk factor for atrial fibrillation, obese patients have lower inpatient mortality when admitted due to atrial fibrillation. This study aims to analyze if the obesity paradox still holds true after weight loss from bariatric surgery. Methods: This study analyzed discharge data from the National Inpatient Sample, 2016-2020. Patients admitted due to atrial fibrillation or atrial flutter, with or without obesity, and with or without a past medical history of bariatric surgery were identified using ICD-10-CM and ICD-10-PCS codes. The primary outcome was mortality. Secondary outcomes included length of stay, resource utilization, necessity for endotracheal intubation, and necessity for cardioversion. STATA v.13 was used for univariate and multivariate analysis (StataCorp LLC, Texas, USA).
Among 2,292,194 patients who had a primary diagnosis of atrial fibrillation or atrial flutter, 494,830 were obese and 25,940 had bariatric surgery. Mortality was not significantly different in post-bariatric surgery patients when compared to the general population (OR 0.76; 95% [CI 0.482-1.2; p=0.24]). Mortality was significantly lower in obese patients when compared to the general population (OR 0.646; 95% [CI 0.583-0.717; p<0.001]). Therefore, post-bariatric surgery patients had a higher mortality than obese patients when compared to the general population. Obese patients spent more days in the hospital (regression 0.219; 95% [CI 0.19-0.248, p<0.001]), had higher resource utilization (regression 3491.995; 95% [CI 2870.085-4113.905, p<0.001]), more cardioversions (OR 1.434; 95% [CI 1.404-1.465; p<0.001]), and no difference in endotracheal intubation rate (OR 1.02; 95% [CI 0.92-1.127; p=0.724]) when compared to the general population. Post-bariatric patients had no difference in length of stay (regression -0.053; 95% [CI -0.137-0.031; p=0.218]) and resource utilization (regression 577.297; 95% [CI -1069.801-2224.396; p=0.492]), fewer endotracheal intubations (OR 0.583; 95% [CI 0.343-0.99; p=0.046]), and more cardioversions (OR 1.223; 95% [CI 1.134-1.32; p<0.001]) when compared to the general population.
Compared to the general population, post-bariatric patients had higher inpatient mortality than obese patients when admitted due to atrial fibrillation or atrial flutter. This research reinforces the presence of the obesity paradox following bariatric surgery with respect to mortality.
“肥胖悖论”声称，尽管肥胖是心房颤动的一个风险因素，但肥胖患者因心房颤动入院时住院死亡率较低。本研究旨在分析减肥手术后体重减轻后肥胖悖论是否仍然成立。方法：本研究分析了2016 - 2020年国家住院患者样本的出院数据。使用ICD - 10 - CM和ICD - 10 - PCS编码识别因心房颤动或心房扑动入院的患者，无论是否肥胖，以及是否有减肥手术既往病史。主要结局是死亡率。次要结局包括住院时间、资源利用、气管插管必要性和心律转复必要性。使用STATA v.13进行单因素和多因素分析（美国德克萨斯州StataCorp有限责任公司）。
在2292194例初步诊断为心房颤动或心房扑动的患者中，494830例为肥胖患者，25940例接受了减肥手术。与普通人群相比，减肥手术后患者的死亡率无显著差异（比值比0.76；95%可信区间[0.482 - 1.2]；p = 0.24）。与普通人群相比，肥胖患者的死亡率显著较低（比值比0.646；95%可信区间[0.583 - 0.717]；p < 0.001）。因此，与普通人群相比，减肥手术后患者的死亡率高于肥胖患者。肥胖患者住院天数更多（回归系数0.219；95%可信区间[0.19 - 0.248]，p < 0.001），资源利用更高（回归系数3491.995；95%可信区间[2870.085 - 4113.905]，p < 0.001），心律转复更多（比值比1.434；95%可信区间[1.404 - 1.465]；p < 0.001），气管插管率与普通人群无差异（比值比1.02；95%可信区间[0.92 - 1.127]；p = 0.724）。与普通人群相比，减肥手术后患者的住院时间无差异（回归系数 - 0.053；95%可信区间[-0.137 - 0.031]；p = 0.218），资源利用无差异（回归系数577.297；95%可信区间[-1069.801 - 2224.396]；p = 0.492），气管插管更少（比值比0.583；95%可信区间[0.343 - 0.99]；p = 0.046），心律转复更多（比值比1.223；95%可信区间[1.134 - 1.32]；p < 0.001）。
与普通人群相比，因心房颤动或心房扑动入院的减肥手术后患者的住院死亡率高于肥胖患者。本研究强化了减肥手术后在死亡率方面存在肥胖悖论这一现象。
