Heart failure as a leading independent predictor for mortality and adverse outcomes after bariatric surgery: analysis using the 2023–2024 MBSAQIP database

Sebastian R.; Zevallos A.; Tuesta O.; Riva A.; Biller J.; Silvers J.; Adrales G.; Li C.; Schweitzer M. · Surgery for Obesity and Related Diseases (2026) · DOI: 10.1016/j.soard.2026.02.006

Resumen

Background: Heart failure (HF) has been associated with postoperative cardiac events and mortality after bariatric surgery. However, recent data remain scarce. Objectives: To compare 30-day outcomes after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in patients with versus without HF and to assess HF as a predictor for adverse outcomes after SG and RYGB. Setting: 2023–2024 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Methods: We analyzed patients with HF who underwent SG and RYGB. A 4:1 propensity score matching analysis was performed, matching 24 preoperative characteristics. We compared 30-day postoperative outcomes in patients with and without HF for both SG and RYGB. Then, 7 multivariate logistic regression analyses were conducted to identify independent predictors for postoperative complications after SG and RYGB. Results: We analyzed 231,243 SG and 96,546 RYGB patients. Outcomes in patients who underwent SG showed that patients with HF had higher rates of mortality, cardiac complications, pulmonary complications, unplanned intensive care unit admissions, readmissions, interventions, nonhome discharge, and postoperative bleeding (P < .05). Outcomes in patients who underwent RYGB had higher rates of mortality, pulmonary complications, renal complications, unplanned intensive care unit admissions, emergency visits, readmissions, and interventions (P < .05). HF was the most significant predictor for 30-day mortality (odds ratio: 4.88; 95% confidence interval: 2.88–8.27; P < .001) following SG and the second most significant predictor (odds ratio: 2.90; 95% confidence interval: 1.37–6.14; P = .005) following RYGB. Conclusions: Patients with HF have a higher rate of mortality and overall complications compared to patients without HF after either SG or RYGB. HF is the strongest independent predictor for 30-day mortality after SG and the second strongest independent predictor after RYGB. Preoperative cardiac optimization is strongly advised in this population.

Instituciones: Universidad Científica del Sur