0854 Obstructive Sleep Apnea with Obesity Hypoventilation Syndrome: Deep Vein Thrombosis Risk After Bariatric Surgery

Abstract Introduction Morbidity and mortality in patients with untreated obesity hypoventilation syndrome (OHS) is significant. The vast majority of OHS patients have concomitant obstructive sleep apnea (OSA), known to be associated with worse cardiovascular outcomes following bariatric surgery. However, there is limited data on the post-bariatric surgery outcomes of patients with OHS. Methods We queried TriNetX Analytics, a federated health record and claims-derived database of >115 million patients across 5 countries. We established two cohorts of patients with OSA (ICD-10-CM G47.33) who underwent laparoscopic bariatric surgery (CPT 1007387) between 5/1/2008-5/1/2023: one with superimposed OHS (E66.2) and one without. We examined the 30-day incidence of deep vein thrombosis [DVT (I82)], pulmonary embolism [PE (I26)], stroke [CVA (I63)], and myocardial infarction [MI (I21)]. We then re-examined these outcomes following extensive in-platform propensity score matching (PSM) to account for demographic and comorbidity antecedents. Results A total of 66,085 bariatric surgery patients were isolated, all in the US. Of these, 26,392 (40%) were diagnosed with OSA prior to surgery, of which 1,176 (1.8%) also carried a diagnosis of OHS. Prior to PSM, the OSA+OHS cohort experienced a significant excess incidence of all outcomes besides CVA when compared to the cohort with OSA alone: DVT risk was 3.9 vs 1.1% (OR 3.5, CI 2.6-4.4), PE risk 2.6 vs 0.9% (OR 3.0, CI 2.1-4.5), composite DVT/PE risk 5.4 vs 1.8% (OR 3.2, CI 2.4-4.1), CVA risk 0.9 vs 0.6%, MI risk 1.4 vs 0.4% (OR 3.3, CI 2.0-5.5), composite CVA/MI risk 2.0 vs 1.0% (OR 2.0, CI. 1.3-3.2). Following PSM, which generated two like sub-cohorts of 1,167 each, significant risk excess was retained only for DVT incidence: DVT risk was 3.8 vs 2.0% (OR 1.9, CI 1.2-3.2), but not for PE risk 2.4 vs 2.1%, DVT/PE risk 5.1 vs 3.7%, CVA risk 0.9 vs 1.2%, MI risk 1.5 vs 1.5%, and CVA/MI risk 2.0 vs 2.4%. Conclusion Our findings suggest that patients with OSA and OHS undergoing bariatric surgery experience similar rates of adverse cardiovascular events in the first postoperative month as those with OSA alone. The exception is DVT risk, which appears greater in the OHS-OSA cohort despite matching. Support (if any)