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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2015

01-02-2015

Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience

Authors: Mohammad H. Jamal, Ricard Corcelles, Hideharu Shimizu, Mathew Kroh, Fernando M. Safdie, Raul Rosenthal, Stacy A. Brethauer, Philip R. Schauer

Published in: Surgical Endoscopy | Issue 2/2015

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Abstract

Introduction

The risk of venous thromboembolic (VTE) events is increased in patients undergoing bariatric surgery. Population studies examining VTE rates after bariatric surgery often lack details and uniformity regarding the prophylactic regimens used. The aim of this study was to determine the incidence of VTE in patients undergoing laparoscopic bariatric surgery.

Methods

Database searches from Cleveland Clinic bariatric surgery programs in Cleveland, OH, and Weston, FL, were conducted from January 2005 to January 2013. Mechanical and chemical prophylaxes were provided for all patients as per protocol. Data on age, gender, body mass index (BMI), interval between procedure and VTE, inpatient versus outpatient status, anticoagulation prophylaxis, type of surgery and mortality were collected.

Results

A total of 4,293 patients underwent primary or revisional bariatric surgery during this 8-year time period. VTE events were identified in 57 patients (1.3 %). Pulmonary embolism (PE) was identified in 39 patients (0.9 %), and 15 of these patients had negative duplex studies of the lower extremities. Deep venous thrombosis only was identified in 18 patients (0.4 %). VTE rates for gastric bypass (n = 2,945), sleeve gastrectomy (n = 709), gastric banding (n = 467) and revisional procedures (n = 171) were 1.1, 2.9, 0.2 and 6.4 %, respectively. Eight patients had VTE diagnosed during their inpatient stay. The mean time to VTE diagnosis after surgery was 24 days. Seventeen patients who developed VTE had been prescribed extended prophylaxis for 2–4 weeks after discharge. There was only one VTE-related mortality from PE reported in this cohort (0.02 %). Univariate and multivariate analyses revealed age, BMI, open and revisional surgery as predictive of VTE (p < 0.05).

Conclusion

The risk of VTE among morbidly obese patients undergoing bariatric surgery is persistent despite use of laparoscopy and aggressive prophylactic anticoagulation policy. Patients with advanced age, higher BMI and those undergoing open or revisional surgery are at higher risk of postoperative VTE.
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Metadata
Title
Thromboembolic events in bariatric surgery: a large multi-institutional referral center experience
Authors
Mohammad H. Jamal
Ricard Corcelles
Hideharu Shimizu
Mathew Kroh
Fernando M. Safdie
Raul Rosenthal
Stacy A. Brethauer
Philip R. Schauer
Publication date
01-02-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3678-4

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