Perirenal fat area is a preoperative predictor of hypertension resolution after laparoscopic sleeve gastrectomy: Generalized additive models

Abstract

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) can lead to complete resolution of hypertension in most patients with obesity within one year. However, the preoperative factors related to this resolution are still unclear.

AIM

To clarify the impact of relevant factors, particularly perirenal fat, on postoperative hypertension resolution.

METHODS

In this retrospective single-center study, a total of 138 patients with obesity and hypertension were included, all of whom underwent LSG in the hospital and were followed up for one year. Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution. Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution, and their predictive values were compared using fivefold cross-validation.

RESULTS

After LSG, 107 patients (77.5%) experienced hypertension resolution, while 31 patients (22.5%) did not achieve resolution. Both the preoperative perirenal fat area (PrFA) and perirenal fat thickness were independent risk factors for postoperative hypertension resolution (P < 0.001 vs P = 0.002). These factors are curvilinearly correlated with the hypertension resolution rate, but PrFA has a better predictive value than perirenal fat thickness dose (area under the curve = 0.846 vs 0.809). Compared with those with PrFA ≥ 18 cm², patients with PrFA < 18 cm² had a higher hypertension resolution rate [87% vs 68.1%; odds ratio (95% confidence interval) = 3.513 (1.367-9.902), P = 0.012].

CONCLUSION

PrFA is a preoperative predictor of postoperative hypertension resolution. It is curvilinearly associated with the resolution rate, and patients with PrFA < 18 cm² have better hypertension resolution outcomes after LSG.

Keywords: Laparoscopic sleeve gastrectomy; Obesity; Hypertension resolution; Perirenal adipose tissue; Perirenal fat area

Core Tip: In this retrospective single-center study, we found that the preoperative perirenal fat area (PrFA), an important factor linking obesity and hypertension, is an independent predictor of hypertension resolution after laparoscopic sleeve gastrectomy. Particularly, PrFA could achieve an accuracy of approximately 85% in predicting resolution using the generalized additive model. Based on the curvilinear correlation between PrFA and resolution rate, we set 18 cm² as the cutoff value for PrFA and found that patients with PrFA < 18 cm² had a higher hypertension resolution rate than those with PrFA ≥ 18 cm² [87% vs 68.1%; odds ratio (95% confidence interval) = 3.513 (1.367-9.902), P = 0.012].