Evaluation of the association between history of open chest or abdominal surgery and cardiovascular risks: an NHANES study, January 2007 – March 2020

Abstract Context The clinical relationship between cardiovascular disease and deleterious surgical outcomes has been extensively examined; however, the relationship between cardiovascular risk and the association with major surgical interventions has yet to be examined at the population level. Previous use of National Health and Nutrition Examination Survey (NHANES) data has investigated the relationship between cardiometabolic risk and a history of bariatric surgery, suggesting that NHANES population data may be a useful tool to uncover a primary association and provide insight into subgroup effects. Objectives This study attempts to quantify the relationships between cardiovascular risk factors and the history of open-chest or abdominal surgery. Methods We analyzed de-identified NHANES data from January 2007 through March 2020 for US adults ≥20 years of age selected via stratified multistage sampling (participants with missing data were excluded; Institutional Review Board [IRB] not required). We extracted self-reported history of open-chest/abdominal surgery (binary), seven metabolic/cardiovascular biomarkers (hemoglobin A 1c [HbA 1c ], low-density lipoprotein [LDL], triglycerides, total cholesterol, systolic/diastolic blood pressure [SBP/DBP], high-density lipoprotein [HDL]), and covariates (race/ethnicity, gender, education, insurance, income-to-poverty ratio). Associations were estimated as odds ratios (ORs) utilizing survey-weighted logistic regression in STATA 16 adjusted for all covariates (two-sided α=0.05), with subpopulation logistic models for subgroup analyses by HbA 1c . Results The elevated HbA 1c level was the only variable that was statistically significant, with an OR of 1.14 (95 % confidence interval [CI], 1.06–1.23). Secondary subgroup analyses demonstrated differential impacts: Non-Hispanic White, individuals without insurance, those with a lower income-to-poverty ratio, females, and individuals with less than a ninth-grade education or a high school/General Education Development (GED) equivalent were more likely to have a surgical history as HbA 1c levels increased. Conclusions A significant association exists between elevated HbA 1c levels and a history of open-chest or abdominal surgery. Specific subgroups are at greater risk and may be disproportionately affected by the downstream consequences of higher HbA 1c levels.