Background

Bariatric surgery for established heart disease (EHD) patients reduces the long-term cardiovascular events and mortality. Short-term complications may limit bariatric surgery utility. Chronic lower limb venous disease (CLLVD) is highly prevalent in the bariatric population and is associated with EHD. Using the 2015-2021 MBSAQIP database, we aimed to evaluate the 30-day outcomes of bariatric surgery in EHD patients with or without CLLVD.

Methods

Patients with EHD (previous MI or cardiac surgery or stent) with CLLVD were selected for the SG and RYGB groups. A 1:2 PSM analysis using 21 preoperative characteristics was performed. First, we compared 30-day outcomes in the EHD vs non-EHD patients. Secondly, we analyzed the EHD patients with or without CLLVD.

Results

Patients with EHD who underwent SG or RYGB had significantly worse 30-day outcomes including higher mortality rates, cardiac and pulmonary complications (Table 1). EHD patients with CLLVD in the SG group showed higher rates of readmissions (8.9% vs. 6.2%, p<0.001), interventions (2.7% vs. 1.6%, p=0.013), venous thromboembolism (0.9% vs. 0.4%, p=0.017), and postoperative bleeding (1.6% vs.0.8%, p=0.016). EHD patients with CLLVD at the time of the RYGB revealed higher rates of renal complications (2.4% vs. 1.2%, p=0.036), unplanned ICU admissions (5.7% vs. 4%, p=0.040), blood transfusions (3.7% vs. 2.3%, p=0.044), readmissions (14.6% vs. 11.3%, p=0.025), and reoperations (5.7% vs. 3.2%, p=0.004).

Conclusions

Patients with EHD who underwent bariatric surgery had more short-term complications and mortality. The complication rate was even higher in EHD patients with CLLVD though sufficiently low to offer bariatric surgery.