Background

Perioperative stroke is a rare but devastating complication after major abdominal surgery. Bariatric Surgery (BaS) patients are a high-risk population for this adverse outcome given their cardiometabolic comorbidities. Recent studies have shown a low but increasing incidence rate of this complication. We aimed to describe patient and procedure related factors that may increase the risk of stroke after primary laparoscopic BaS.

Methods

We performed a retrospective analysis of the MBSAQIP database for patients aged >=18 years old undergoing laparoscopic sleeve gastrectomy (LSG) and Roux en Y gastric bypass (LRYGB) during 2015-2019. Data on demographics, comorbidities and type of procedure were collected. The primary outcome of the study was the incidence of stroke. Secondary outcomes included 30-day complications and mortality. Univariate analysis was performed to look for any differences between patients with and without stroke; a multivariate logistic regression model was performed to determine clinical predictors.

Results

A total of 752,722 patients were included in our analysis. Stroke occurred in 97 patients (0.012%). Univariate analysis showed that patients with postoperative stroke had higher rates of adverse 30-days outcomes (Table 2), with a mortality rate as high as 10.3%. Multivariable analysis showed that the predictors of perioperative stroke were having a history of chronic kidney disease, being on anticoagulation therapy and age > 45 years (Table 3).

Conclusions

Postoperative stroke is associated with significantly adverse 30-day outcomes in patients undergoing BaS. Our analysis showed that a history of chronic kidney disease was the most relevant independent predictor of stroke.