Heart Failure Independently Predicts Higher Morbidity and Mortality Following Bariatric Surgery: Analysis of 180,544 MBSAQIP Cases

Heart failure (HF) and obesity represent intersecting public health epidemics with significant healthcare implications. As obesity-related heart failure becomes increasingly prevalent, understanding the perioperative risks and outcomes of bariatric surgery in this vulnerable population is essential. This study aimed to analyze procedure-specific outcomes and cardiac complications in heart failure patients undergoing primary bariatric surgery using a large multi-institutional database. We conducted a retrospective analysis using the 2023 MBSAQIP database, examining adult patients who underwent primary laparoscopic bariatric procedures (sleeve gastrectomy or Roux-en-Y gastric bypass). Patients were stratified into heart failure and non-heart failure cohorts. The primary outcomes evaluated were 30-day serious complications and mortality. Multivariable logistic regression analyses were performed to identify independent predictors of complications and mortality, adjusting for demographics, comorbidities, and operative factors. Among 180,544 patients, 2,842 (1.6%) had pre-existing heart failure documented preoperatively. HF patients were significantly older (53.3 ± 11.0 vs. 42.8 ± 11.8 years, p < 0.001) with higher BMI (48.6 ± 9.5 vs. 45.0 ± 7.7 kg/m², p < 0.001) and greater comorbidity burden. Procedure distribution was similar between groups (SG: 70.7% vs. 72.1%, RYGB: 29.3% vs. 27.9%, p = 0.091). HF patients experienced significantly higher rates of serious complications (7.2% vs. 2.4%, p < 0.001) and mortality (0.74% vs. 0.06%, p < 0.001). Cardiac events occurred 13 times more frequently in HF patients (1.3% vs. 0.1%, p < 0.001). Hospital length of stay was longer (1.9 ± 2.9 vs. 1.2 ± 1.0 days, p < 0.001), with higher readmission rates (7.8% vs. 2.8%, p < 0.001). On multivariable analysis, pre-existing HF was the strongest independent predictor of serious complications (OR 1.81; 95% CI 1.55–2.13; p < 0.001) and a powerful predictor of 30-day mortality (OR 3.64; 95% CI 2.14–6.20; p < 0.001). Heart failure is a major independent predictor of both serious complications and mortality following bariatric surgery, occurring in nearly 2% of all elective cases. Despite the established long-term benefits of bariatric surgery for HF patients, the substantially elevated perioperative risks require careful patient selection, thorough preoperative cardiac assessment, and specialized perioperative management strategies to optimize outcomes in this high-risk population. Pre-existing heart failure is present in 1.6% of bariatric surgery patients and increases postoperative mortality nearly 12-fold. Heart failure is amongst the strongest independent predictors of serious complications (OR 1.81). Heart failure independently predicts 30-day mortality (OR 3.64) after bariatric surgery. Cardiac events are 13 times more frequent in heart failure patients undergoing bariatric surgery. Heart failure patients experience longer hospital stays and higher readmission rates.