Bariatric surgery association with risk of recurrent stroke hospitalization among older stroke survivors with obesity: A national inpatient sample study (2016-2019).

Background and aims: The paucity of large-scale data exploring the effect of prior bariatric surgery on recurrent stroke outcomes in older individuals with obesity who survived a stroke led us to address the gap, with an emphasis on the risk of recurrent stroke and its trends. Methods: Retrospective analysis of the National Inpatient Sample data from 2016 to 2019. Older individuals with obesity who survived a stroke (>65 years) and had a recurrent acute ischemic stroke (AIS) hospitalization, with or without prior bariatric surgery (PBS), were identified using ICD-10 codes. Recurrent stroke trends, demographic characteristics, and comorbidities between the cohorts were compared. Results: Analyzing 643,505 older individuals with obesity who survived a stroke, we identified that 11,820 had undergone PBS. Both groups (no PBS vs. PBS) were predominantly female (59.7 % vs. 73.7 %), identified as white (76.5 % vs. 83.8 %), and covered by Medicare (91.7 % vs. 90.7 %). Diabetes, hyperlipidemia, prior myocardial infarction, and peripheral vascular diseases were more common in those without PBS. In contrast, tobacco use disorder, drug abuse, and valvular diseases were more common in those with PBS. There was no significant difference in the prevalence of hypertension between groups.Between 2016 and 2019, recurrent AIS hospitalizations were less frequent in the PBS group (4 %-2.9 %, p = 0.035) while remaining stable in the other group (4.4 %-4.2 %, p = 0.064). The risk of recurrent AIS hospitalization was less frequent in the PBS cohort (aOR: 0.77, 95 % CI: 0.60-0.98). Conclusion: PBS in older individuals with obesity who survived a stroke was associated with a 23 % lower risk of recurrent AIS hospitalization with a decreasing trend of prevalence since 2016. These findings could influence clinical practice and contribute to developing secondary prevention strategies for recurrent stroke among these patients.

Meta-analysis of renin angiotensin aldosterone modulators mitigating Atrial Fibrillation risk in hypertensive patients.

INTRODUCTION: Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF. METHODS: PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method. RESULTS: 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results. CONCLUSIONS: ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.

The role and timing of endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis without cholangitis: A nationwide analysis.

BACKGROUND/PURPOSE: The role and optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis without cholangitis (ABPwoC) remains unclear. Using a large national database, we aimed to examine hospitalization outcomes of patients with ABPwoC as a function of the performance and timing of ERCP. METHODS: This was a retrospective study of adult patients with ABPwoC utilizing the National Inpatient Sample from 2016-2017. Patients who underwent inpatient ERCP were stratified into performance: within 24, 24-48, 48-72, and >72 h of hospital admission. The primary outcome was all-cause inpatient mortality as a function of the performance and timing of ERCP; secondary outcomes, including healthcare utilization, were assessed. Multivariate modeling was used to adjust for potential confounders. Statistical analyses were conducted using STATA, version 16.0. RESULTS: Of the 70 030 patients with ABPwoC, 31.37% underwent inpatient ERCP. Performance (aOR: 0.6, p < .05), but not timing (aOR: 0.98, p = .9), of inpatient ERCP was associated with significantly lower all-cause inpatient mortality. Urgent ERCP (within 24 h) was associated with shorter hospital length of stay, lower charges and cost, and less need for pancreatic drainage procedures, while ERCP within 72 h was associated with less frequent intensive care unit admission (all p < .05). DISCUSSION: Based on this large, nationwide analysis, inpatient ERCP for ABPwoC is associated with lower all-cause mortality. ERCP within 24 and 72 h, though not associated with lower mortality, are associated with multiple improved clinical outcomes, including lower healthcare charges and costs.

WITHDRAWN: Non-Anti-TNF Biologics as Salvage Therapy for Refractory Acute Severe Ulcerative Colitis, A Systematic Review

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