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Does Bariatric Surgery Change the Risk of Acute Ischemic Stroke in Patients with History of Transient Ischemic Attack? A Nationwide Analysis

Published:November 22, 2022DOI:https://doi.org/10.1016/j.soard.2022.11.013

      Highlights

      • 1.
        Subjects with obesity have an increased risk of developing an ischemic stroke after a transient ischemic attack.
      • 2.
        In this study, bariatric surgery was shown to decrease the risk of ischemic stroke in patients with a prior transient ischemic attack.
      • 3.
        A positive impact on hospital stay length and total charges of hospitalization was observed.

      ABSTRACT

      SETTING

      Academic Hospital, United States.

      BACKGROUND

      Stroke is the second leading cause of death worldwide and fifth in the US and represents the major cause of disability in older adults. We aim to determine risk of acute ischemic stroke (AIS) in individuals with obesity with history of transient ischemic attack (TIA) compared to patients with history of bariatric surgery.

      METHODS

      Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them in two groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups, using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, comorbidities (diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment).

      RESULTS

      A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n=11284) and control patients 87.6% (n=80356). The average age of the treatment group was 62.9 ± 17.08 years, and average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared to control group (2.8% vs. 4.2%, p<0.0001). After adjusting for covariables, the risk difference of AIS was still significant between control and treatment groups (OR=1.33, p<0.0001), showing that patients in treatment group were less likely to have an AIS compared to control group.

      CONCLUSIONS

      After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.

      KEYWORDS

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