Bariatric surgery association with risk of recurrent stroke hospitalization among older stroke survivors with obesity: A national inpatient sample study (2016–2019)

Background and aims

The paucity of large-scale data exploring the effect of prior bariatric surgery on recurrent stroke outcomes in older individuals with obesity who survived a stroke led us to address the gap, with an emphasis on the risk of recurrent stroke and its trends.

Methods

Retrospective analysis of the National Inpatient Sample data from 2016 to 2019. Older individuals with obesity who survived a stroke (>65 years) and had a recurrent acute ischemic stroke (AIS) hospitalization, with or without prior bariatric surgery (PBS), were identified using ICD-10 codes. Recurrent stroke trends, demographic characteristics, and comorbidities between the cohorts were compared.

Results

Analyzing 643,505 older individuals with obesity who survived a stroke, we identified that 11,820 had undergone PBS. Both groups (no PBS vs. PBS) were predominantly female (59.7 % vs. 73.7 %), identified as white (76.5 % vs. 83.8 %), and covered by Medicare (91.7 % vs. 90.7 %). Diabetes, hyperlipidemia, prior myocardial infarction, and peripheral vascular diseases were more common in those without PBS. In contrast, tobacco use disorder, drug abuse, and valvular diseases were more common in those with PBS. There was no significant difference in the prevalence of hypertension between groups.

Between 2016 and 2019, recurrent AIS hospitalizations were less frequent in the PBS group (4 %–2.9 %, p = 0.035) while remaining stable in the other group (4.4 %–4.2 %, p = 0.064). The risk of recurrent AIS hospitalization was less frequent in the PBS cohort (aOR: 0.77, 95 % CI: 0.60–0.98).

Conclusion

PBS in older individuals with obesity who survived a stroke was associated with a 23 % lower risk of recurrent AIS hospitalization with a decreasing trend of prevalence since 2016. These findings could influence clinical practice and contribute to developing secondary prevention strategies for recurrent stroke among these patients.