Impact of Bariatric Surgery on Outcomes of Patients with Sickle Cell Disease: a Nationwide Inpatient Sample Analysis, 2004–2014

Abstract

Background

With advances in disease-specific treatments and improved overall survival, obesity rates are rising among patients with sickle cell disease (SCD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized obese patients with SCD.

Methods

The United States Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and SCD. The primary outcome was in-hospital mortality. Secondary outcomes included vaso-occlusive crisis, acute chest syndrome, biliary-pancreatic complications, renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, strictures, wound infection, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery.

Results

Among 2549 patients with a discharge diagnosis of SCD and morbid obesity, only 42 patients (1.7%) had bariatric surgery. On multivariable analysis, bariatric surgery did not influence mortality (P = 0.98). Bariatric surgery was not associated with increased risk for acute chest syndrome, sepsis, multi-organ failure, biliary-pancreatic, or surgery-related complications (all P > 0.05). Interestingly, bariatric surgery decreased risk of vaso-occlusive crises (IRR 0.21; 95% CI, 0.07–0.69; P = 0.01) in these patients and was associated with a shorter length of stay (P < 0.001) but higher hospitalization costs (P < 0.001).

Conclusions

Bariatric surgery may lower rates of vaso-occlusive crises in morbidly obese sickle cell patients without significantly affecting mortality and other adverse outcomes. In spite of this, these weight loss surgeries are underutilized in this select population.

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Financial Support

This study was supported by NIH 5 T32 DK 7356-37 (BN).

This article has not been published and is not under consideration elsewhere.

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Contributions

Study concept and design—Sharma P, McCarty TR, and Njei B. Paper preparation—Sharma P and McCarty TR. Statistical analysis—Njei B. Critical revisions—McCarty TR, Yadav S, Ngu JN, and Njei B. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Basile Njei.

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Prabin Sharma and Thomas R. McCarty are co-first authors

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Sharma, P., McCarty, T.R., Yadav, S. et al. Impact of Bariatric Surgery on Outcomes of Patients with Sickle Cell Disease: a Nationwide Inpatient Sample Analysis, 2004–2014. OBES SURG 29, 1789–1796 (2019). https://doi.org/10.1007/s11695-019-03780-0

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Keywords

  • Sickle cell disease (SCD)
  • Obesity
  • Bariatric surgery
  • Weight loss
  • Weight gain
  • Vaso-occlusive crisis