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Bariatric Surgery and the Long-Term Risk of Venous Thromboembolism: A Population-Based Cohort Study

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Abstract

Purpose

Bariatric surgery is associated with a greater venous thromboembolism (VTE) risk in the weeks following surgery, but the long-term risk of VTE is incompletely characterized. We evaluated bariatric surgery in relation to long-term VTE risk.

Materials and Methods

This population-based retrospective matched cohort study within three United States–based integrated health care systems included adults with body mass index (BMI) ≥ 35 kg/m2 who underwent bariatric surgery between January 2005 and September 2015 (n = 30,171), matched to nonsurgical patients on site, age, sex, BMI, diabetes, insulin use, race/ethnicity, comorbidity score, and health care utilization (n = 218,961). Follow-up for incident VTE ended September 2015 (median 9.3, max 10.7 years).

Results

Our population included 30,171 bariatric surgery patients and 218,961 controls; we identified 4068 VTE events. At 30 days post-index date, bariatric surgery was associated with a fivefold greater VTE risk (HRadj = 5.01; 95% CI = 4.14, 6.05) and a nearly fourfold greater PE risk (HRadj = 3.93; 95% CI = 2.87, 5.38) than no bariatric surgery. At 1 year post-index date, bariatric surgery was associated with a 48% lower VTE risk and a 70% lower PE risk (HRadj = 0.52; 95% CI = 0.41, 0.66 and HRadj = 0.30; 95% CI = 0.21, 0.44, respectively). At 5 years post-index date, lower VTE risks persisted, with bariatric surgery associated with a 41% lower VTE risk and a 55% lower PE risk (HRadj = 0.59; 95% CI = 0.48, 0.73 and HRadj = 0.45; 95% CI = 0.32, 0.64, respectively).

Conclusion

Although in the short-term bariatric surgery is associated with a greater VTE risk, in the long-term, it is associated with a substantially lower risk.

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Funding

The study was funded by NIH/NIDDK R01DK105960-01. Dr. Harrington was funded by a grant from the NHLBI (K01HL139997). Sponsors did not play a role in the collection, management, analysis or interpretation of data, the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Ste. 1600, Seattle, WA, 98101, USA

    Laura B. Harrington, Eric Johnson, Mary Kay Theis, Julie Cooper, Christopher R. Daigle, Julietta H. Chang & David E. Arterburn

  2. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, 98195, USA

    Laura B. Harrington

  3. Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA

    Laura B. Harrington

  4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA

    Luke Benz & Sebastien Haneuse

  5. Kaiser Permanente Southern California, Pasadena, CA, 91101, USA

    Karen J. Coleman, Philip L. Chin, Scott S. Um & Jorge Zelada Getty

  6. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

    Anita P. Courcoulas

  7. Kaiser Permanente Northern California, Oakland, CA, 94611, USA

    Robert A. Li, Gary G. Grinberg & Panduranga R. Yenumula

  8. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, 98104, USA

    David E. Arterburn

Authors
  1. Laura B. Harrington
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Corresponding author

Correspondence to Laura B. Harrington.

Ethics declarations

Ethical Approval

For this type of study formal consent is not required.

Consent to Participate

Informed consent does not apply.

Conflict of Interest

Anita P. Courcoulas had a research grant from Allurion Inc. David E. Arterburn has grants from NIH and PCORI; a contract from Sharecare, Inc.; and received reimbursements for travel expenses from the American Society of Metabolic and Bariatric Surgery. Karen J. Coleman has funding for research from NIDDK, NHLBI, NIMH, and FDA and is paid a stipend for reviewing grants for NIH (outside of the submitted work). No authors have spouses, partners, or children that have financial relationships that may be relevant to the submitted work. Laura B. Harrington, Luke Benz, Sebastien Haneuse, Eric Johnson, Robert A. Li, Mary Kay Theis, Julie Cooper, Philip L. Chin, Gary G. Grinberg, Christopher R. Daigle, Julietta H. Chang, Scott S. Um, Panduranga R. Yenumula, and Jorge Zelada Getty have nothing to declare.

Data Access, Responsibility, and Analysis

Luke Benz, Sebastien Haneuse, and David Arterburn had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Data Sharing

Study participants did not give written consent for their data to be shared publicly, and the data contain protected health information governed by the US Health Insurance Portability and Accountability Act (HIPAA). Because of this, we do not plan to publicly share data; however, authors will respond to reasonable requests, with permission of all health systems involved and a fully executed data use agreement. In the interest of reproducibility, code used for all analyses is available on GitHub at https://github.com/lbenz730/arterburn_vte/.

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Key Points

• Long-term VTE risk post-bariatric surgery is incompletely characterized.

• Our large population-based matched cohort included adults with severe obesity.

• Bariatric surgery was associated with a significantly lower risk of VTE long-term.

• This supports balanced consideration of short-term risks and long-term benefits.

Supplementary Information

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Supplementary file1 (DOCX 495 KB)

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Harrington, L.B., Benz, L., Haneuse, S. et al. Bariatric Surgery and the Long-Term Risk of Venous Thromboembolism: A Population-Based Cohort Study. OBES SURG 34, 2017–2025 (2024). https://doi.org/10.1007/s11695-024-07236-y

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