Background

Metabolic surgery is among the most effective treatments available for patients with severe obesity. There is a risk for perioperative myocardial infarction (PMI) in patients who undergo this type of surgery, although there is limited literature on the specific risk factors associated with PMI. This study aimed at identifying risk factors associated with PMI in patients undergoing metabolic surgery.

Methods

A retrospective analysis was performed using the MBSAQIP participant usage file (PUF) database between 2015 and 2019. With a total of 966,646 patients, we identified demographics, comorbidities, and surgical variables, and later compared them to the PMI outcome. Chi-square analysis was run for non-parametric variables and an independent sample t-test was used for parametric variables. The statistical significance threshold used was p<0.05.

Results

The incidence of PMI was 0.03%, where 80.5% of the population were females. Male gender, white race, and cardiovascular and metabolic medical illnesses, among others, were significantly associated with PMI (p<0.05). Surprisingly, smoking and higher BMI were not associated with PMI (p=0.175 and p=0.214, respectively). Robotic-assisted surgery was associated with a lower risk of PMI compared to conventional laparoscopy and open surgery regardless of the metabolic procedure performed (p<0.05).

Conclusions

The risk for PMI in patients undergoing metabolic surgery is relatively low and robotic surgery might be option for patients at higher risk. The identification of these risk factors can provide perioperative guidelines for screening, help define the optimal surgical plan, and aid high-risk patients who seek metabolic surgery to improve their quality of life.