Abstract
BACKGROUND: The metabolic benefits of bariatric surgery are well established. However, its effects on cardiovascular surgery morbidity and mortality are not well understood. METHODS: Between 2016 and 2021, the Nationwide Inpatient Sample included 343,975 discharges from bariatric surgery eligible candidates who underwent coronary artery bypass grafting, valve, aortic, or combination surgery. Among these were 11,035 (3.2%) patients with a diagnostic code for bariatric surgery. Balancing-score matching was used to mitigate confounding factors between patients who underwent bariatric surgery compared to their eligible counterparts who qualified for bariatric surgery but did not receive it. Obesity class subgroup analyses were also conducted following the same approach. RESULTS: Among balancing-score–matched pairs, patients with bariatric surgery had lower hospital mortality (0.9% vs. 1.7% P=.03), fewer respiratory (pneumonia 4.2% vs. 6.9%, P<.001, respiratory failure 8.4% vs. 11%, P=.003) and infectious complications (1.2% vs. 2.0%, P=.03). However, in the obesity class 1 and 2 subgroups, outcomes were similar. Obesity class 3 patients with bariatric surgery had fewer pneumonia and infections compared to their counterparts. CONCLUSIONS: When comparing patients with and without a history of bariatric surgery, BMI may be an important confounder impacting cardiovascular surgery outcomes. Care teams should aim for metabolic optimization to improve surgical outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11695-026-08548-x.