Background

The implications of pre-operative atrial dysrhythmias (ADs) in patients undergoing bariatric surgery are poorly understood. The aims of this study are to characterize the prevalence of atrial dysrhythmias for elective bariatric surgery patients and to explore their impact on postoperative outcomes.

Methods

Data was extracted from the MBSAQIP data registry from 2015 to 2019. All primary Roux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) procedures were included. Patients with Ads were identified as patients coded as receiving pre-operative therapeutic anticoagulation without a prior history of history of deep vein thrombosis, venous thromboembolism , pulmonary embolism, or other conditions requiring anticoagulation. Multivariable logistic regression analysis was used to determine the impact of pre-operative ADs on post-operative complications and 30-day mortality.

Results

A total of 751,952 patients were identified, of which only 20,800 (2.8%) had preoperative ADs. Subjects with ADs were more likely to be older, have a higher body mass index. Metabolic comorbidities were also more common in those with AD as demonstrated by higher rates of diabetes, hypertension, dyslipidemia, and prior history of myocardial infarction. Rates of 30-day serious complications were higher in the AD cohort. After adjusting for comorbidities using multivariable logistic regression, AD was the single greatest independent predictor of serious complications and 30-day mortality.

Conclusions

Atrial dysrhythmias were observed in approximately 3% of MBSAQIP patients. ADs are among the greatest independent predictors of serious complications and mortality suggesting that these patients are associated with a higher peri-operative risk profile warranting further optimization.