Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population

BACKGROUND The long-term effect of bariatric surgery on cardiovascular outcomes in the elderly population is not well studied. OBJECTIVES The aim of this study was to evaluate the association between bariatric surgery and long-term cardiovascular outcomes in the Medicare population. METHODS Medicare beneficiaries who underwent bariatric surgery from 2013 to 2019 were matched to a control group of patients with obesity with a 1:1 exact matching based on age, sex, body mass index, and propensity score matching on 87 clinical variables. The study outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. An instrumental variable analysis was performed as a sensitivity analysis. RESULTS The study cohort included 189,770 patients (94,885 matched patients in each group). By study design, the 2 groups had similar age (mean: 62.33 +/- 10.62 years), sex (70% female), and degree of obesity (mean body mass index: 44.7 +/- 7.3 kg/m(2)) and were well balanced on all clinical variables. After a median follow-up of 4.0 years (IQR: 2.4-5.7 years), bariatric surgery was associated with a lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; HR: 0.63; 95% CI: 0.60-0.66), new-onset HF (HR: 0.46; 95% CI: 0.44-0.49), MI (HR: 0.63; 95% CI: 0.59-0.68), and stroke (HR: 0.71; 95%: CI: 0.65-0.79) (P < 0.001). The benefit of bariatric surgery was evident in patients who were 65 years and older. Using instrumental variable analysis, bariatric surgery was associated with a lower risk of mortality, HF, and MI. CONCLUSIONS Among Medicare beneficiaries with obesity, bariatric surgery is associated with lower risk of mortality, new-onset HF, and MI. (c) 2022 by the American College of Cardiology Foundation.