Bariatric surgery is associated with reduced admission for aortic dissection: a nationwide case-control analysis

Background: Aortic dissection (AD) is an uncommon but life-threatening condition associated with high morbidity and mortality. Hypertension (HTN) and hyperlipidemia (HLD) are common modifiable risk factors. Objectives: Since bariatric surgery is associated with remission of obesity-related co-morbidities, we hypothesize that surgical weight loss might be protective against this feared aortic pathology. Setting: A cross-sectional analysis was performed using the National Inpatient Sample database from 2010 to 2015. Methods: The treatment group included bariatric patients and the control group patients with obesity (body mass index [BMI] >= 35kg/m(2)) without previous bariatric surgery. Analyzed covariates included demographics, co-morbidities, aortic diseases, and AD. A multivariate logistic regression analysis (MLRA) was performed to assess the odds of admission for AD in both groups. Results: A total of 2,300,845 patients were identified (2,004,804 controls and 296,041 cases). The mean (SEM) age was 54.4 (.05) versus 51.9 (.05) years, for the control and treatment groups, respectively (P<.0001). Bariatric patients posed a significantly lower prevalence of type 2 diabetes (T2D), HTN, HLD, aortic aneurysm, and bicuspid aortic valve (P<.0001) than control subjects. In the control group, 1411 individuals (.070%) had AD, whereas only 94 patients (.032%) in the bariatric surgery group had such diagnosis (P<.0001). The MLRA showed that non-bariatric obese patients had a significantly higher likelihood of suffering from AD (OR = 1.8 [95%CI 1.44-2.29] P<.0001). Considering different age groups, bariatric surgery was found to be less associated with admission for AD for individuals below and above 40 years of age (OR = 2.95 [95%CI 1.09-7.99] P = .0345) and (OR = 1.75 [95%CI 1.38-2.22] P<.0001), respectively. Conclusions: Bariatric surgery could be a protective factor against aortic dissection and should be considered in patients with obesity and risk factors for this cardiovascular complication. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

Aortic dissection is a life-threatening condition associated with high morbidity and mortality, commonly linked to hypertension and hyperlipidemia. This study found that bariatric surgery patients had a significantly lower prevalence of risk factors and aortic diseases compared to obese patients who did not undergo surgery. Bariatric surgery may be a protective factor against aortic dissection, especially for obese individuals at risk for cardiovascular complications.