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Background

Studies examining recent trends in postoperative major adverse cardiovascular events (MACE) in bariatric surgery (BaS) for accredited and non-accredited centers, as well as the factors underlying these trends, are lacking.

Methods

Using the 2012-2019 National Inpatient Sample, laparoscopic sleeve gastrectomy (LSG), open sleeve gastrectomy (OSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and open Roux-en-Y gastric bypass (ORYGB) were examined. A composite MACE (acute myocardial infarction, cardiac arrest, acute stroke, and in-hospital death during BaS hospitalization) was calculated and analyzed over time along with patient demographics and comorbid diseases using survey-weighted logistic regression .

Results

MACE incidence from 2012 to 2019 was lowest for LSG (0.07%), followed by LRYGB (0.16%), OSG (1.54%) and ORYBG (2.24%). Over time, MACE decreased for LRYGB (OR: 0.91 (0.85-0.99) p=0.0211) and OSG (OR: 0.86 (0.75-0.97) p=0.016). Unadjusted estimates demonstrated an apparent increase in MACE for ORYGB (OR 1.1 (1.01-1.2) p= 0.0383). However, following covariate adjustment, MACE incidence decreased for LRYGB (OR: 0.91 [0.84-0.99] p=0.0254), LSG (OR 0.92 [0.84 -1] p=0.0487), and OSG (0.82 [0.71-0.95] p=0.0068), while ORYGB remained unchanged (1.02 [0.92-1.12] p=0.7507). Length of stay for MACE patients did not decrease over time for LRYGBP (OR 1.07 [0.99-1.15] p=0.082, LSG (OR 0.93 [0.86-1] p=0.065, ORYGBP (OR 0.97 [0.89 -1.07] p=0.552, OSG (OR 1.16 [0.94-1.44] p=0.165).

Conclusions

MACE in LSG and LRYGB continues to be a rare outcome, occurring in 0.1% of patients. High risk comorbid conditions and demographics have not precluded improvements in MACE outcomes in BaS over time.