Impact of prior bariatric surgery on outcomes of hospitalized patients with heart failure: a population-based study

Background: Studies have suggested that obesity could improve prognosis in patients with heart failure (HF), known as the “obesity paradox.” However, the association between bariatric surgery (BS) and HF outcomes is not well established. Objective: This study aimed to assess the effects of prior BS on outcomes of HF patients. Setting: Inpatient hospital admissions from the Nationwide Inpatient Sample. Methods: The Nationwide Inpatient Sample database for years 2006 to 2014 was queried for adults with a primary diagnosis of HF. We performed multivariable regression analyses to compare outcomes including in-hospital mortality, complications, cost, and length of stay between prior BS (body mass index <35 and ≥35 kg/m²) and morbid obesity. Results: Of 164,220 patients with HF, 3617 were with prior BS and 160,603 were diagnosed with morbid obesity. Prior BS patients were younger, tended to be female, and had fewer co-morbidities and complications. Multivariate regression analyses adjusting for baseline patient and hospital characteristics revealed that compared with morbid obesity, prior BS with successful weight loss (body mass index <35 kg/m²) was associated with decreased mortality (odds ratio: .47; 95% confidence interval: .37–.74), urinary tract infection (odds ratio: .72; 95% confidence interval: .62–.84), 17% shorter hospitalization (median length of stay: 2.99 and 3.95 days), and 7% lower cost (median cost: $6984 and $7775). Propensity score-matching analysis validated main findings with permissible similarity regarding covariates between groups. Conclusion: Among HF hospitalized patients, prior BS is associated with better in-hospital outcomes, mainly in those who had successful weight loss. Our findings emphasize potential clinical and economic impact of BS on HF patients.