Exercise Stress Testing and Cardiac Outcomes in Pediatric Patients Undergoing Bariatric Surgery
Presented By:
Brooke T. Davey, Matthew Cummins, James Healy, Melissa Santos, Christine M. Finck
Connecticut Children's Medical Center
MCummins@connecticutchildrens.orgOverview:
Background: Bariatric surgery at programs with multidisciplinary subspecialty expertise is an effective treatment for severely obese pediatric patients. Exercise stress testing (EST) is a common component of preoperative clearance for bariatric surgery in the adult population due to the increased incidence of coronary artery disease in obese adults. The purpose of this study is to review EST results and perioperative cardiac outcomes to assess the need for EST for cardiac clearance prior to bariatric surgery in pediatric patients.
Methods: A retrospective chart review was performed evaluating EST for bariatric surgery patients at CT Children’s between March 2020 and February 2022. In addition to demographic data, categorical variables, including blood pressure and heart rate responses to exercise, presence of ectopic beats, pathologic arrhythmia, ST changes during exercise, and final results were summarized using percentages or frequencies. Adverse cardiac outcome data from the intra-operative and post-operative period were also collected.
Results: Fifty-two participants underwent a simple cardiac stress test according to the Bruce protocol prior to bariatric surgery. The average age was 16.7 years. All participants were cisgender with 84.6% female. Race/ethnicity was black/African American (36.5%), Hispanic (42.3% of which 3 also identified as black) and white (25.0%). Average preoperative BMI was 47.8. EST data demonstrated an average work level achieved of 8.1 METS; average exercise time was 6 minutes 19 seconds. Exaggerated heart rate response to exercise, consistent with deconditioning, was observed in 22/52 (42.3%) participants; 41/52 (78.8%) subjects produced a maximal effort. Blood pressure response to exercise was normal in 100.0% of patients, 98.1% had no ectopic beats, and 100.0% had no runs of pathologic arrhythmia. None had ST changes. Excluding signs of deconditioning, all EST results were normal. No cardiac adverse events were appreciated in the operative or postoperative period, including hemodynamic instability requiring inotropic support, pathologic arrhythmias, syncope, chest pain with elevated cardiac enzymes, cardiac arrest, or death. Elimination of EST prior to bariatric surgery would impart an estimated cost savings of $26,728/year.
Conclusions: Exercise stress testing did not demonstrate significant abnormalities and no cardiac adverse events occurred in pediatric patients undergoing bariatric surgery at CT Children’s between March 2020 and February 2022. These findings suggest that due to the lower risk of coronary artery disease in the pediatric population, preoperative EST may be safely reserved for select high risk patients, such as those with symptoms of exertional chest pain or exercise intolerance, abnormal lipid screening, or an abnormal echocardiogram.
Methods: A retrospective chart review was performed evaluating EST for bariatric surgery patients at CT Children’s between March 2020 and February 2022. In addition to demographic data, categorical variables, including blood pressure and heart rate responses to exercise, presence of ectopic beats, pathologic arrhythmia, ST changes during exercise, and final results were summarized using percentages or frequencies. Adverse cardiac outcome data from the intra-operative and post-operative period were also collected.
Results: Fifty-two participants underwent a simple cardiac stress test according to the Bruce protocol prior to bariatric surgery. The average age was 16.7 years. All participants were cisgender with 84.6% female. Race/ethnicity was black/African American (36.5%), Hispanic (42.3% of which 3 also identified as black) and white (25.0%). Average preoperative BMI was 47.8. EST data demonstrated an average work level achieved of 8.1 METS; average exercise time was 6 minutes 19 seconds. Exaggerated heart rate response to exercise, consistent with deconditioning, was observed in 22/52 (42.3%) participants; 41/52 (78.8%) subjects produced a maximal effort. Blood pressure response to exercise was normal in 100.0% of patients, 98.1% had no ectopic beats, and 100.0% had no runs of pathologic arrhythmia. None had ST changes. Excluding signs of deconditioning, all EST results were normal. No cardiac adverse events were appreciated in the operative or postoperative period, including hemodynamic instability requiring inotropic support, pathologic arrhythmias, syncope, chest pain with elevated cardiac enzymes, cardiac arrest, or death. Elimination of EST prior to bariatric surgery would impart an estimated cost savings of $26,728/year.
Conclusions: Exercise stress testing did not demonstrate significant abnormalities and no cardiac adverse events occurred in pediatric patients undergoing bariatric surgery at CT Children’s between March 2020 and February 2022. These findings suggest that due to the lower risk of coronary artery disease in the pediatric population, preoperative EST may be safely reserved for select high risk patients, such as those with symptoms of exertional chest pain or exercise intolerance, abnormal lipid screening, or an abnormal echocardiogram.
