Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences
- 161 Downloads
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common, safe and effective bariatric procedure. Bleeding is a significant source of postoperative morbidity. We aimed to determine the incidence, outcomes, and predictors of postoperative bleeding after LRYGB.
LRYGB patients included in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset were identified. Preoperative and intraoperative factors were tested for associations with bleeding using univariable and multivariable logistic regression analysis. Outcomes of length of stay, in-hospital mortality, 30-day mortality, discharge disposition, and 30-day complications among patients with and without clinically significant postoperative bleeding were compared using multivariable regression.
In the 43,280 LRYGB patients included in this analysis, postoperative bleeding occurred in 652 (1.51%) patients. Of these, 165 (25.3%) underwent a re-operation and 97 (14.9%) underwent an unplanned endoscopy for ‘bleeding’. Postoperative bleeding was associated with a longer median postoperative length of stay (4 vs. 2 days), higher in-hospital mortality (1.23 vs. 0.04%), higher 30-day mortality (1.38 vs. 0.15%), discharge to an extended-care facility (3.88 vs. 0.6%), and higher rates of major complications (all P < 0.05). Independent predictors of postoperative bleeding included; a history of renal insufficiency (OR 2.55, 95% CI 1.43–4.52), preoperative therapeutic anticoagulation (OR 2.44, 95% CI 1.69–3.53), and revisional surgery (OR 1.45, 95% CI 1.06–1.97). Intraoperative associated factors included conversions (OR 3.37, 95% CI 1.42–7.97), and drain placement (OR 1.40, 95% CI 1.18–1.67). Robotic approaches resulted in independently lower postoperative bleeding rates (OR 0.50, 95% CI 0.32–0.77).
Postoperative bleeding occurs in 1.5% of patients undergoing a LRYGB and is associated with significantly increased morbidity and mortality. We have identified patient and operative factors that are independently associated with postoperative bleeding.
KeywordsBariatric surgery Complications Weight loss surgery Outcomes
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) the hospitals participating in the MBSAQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Compliance with ethical standards
Syed Nabeel Zafar, Jessica Felton, Kaylie Miller, Eric S. Wise, and Mark Kligman have no conflicts of interest or financial ties to disclose.
- 6.Kligman MD, Thomas C, Saxe J (2003) Effect of the learning curve on the early outcomes of laparoscopic Roux-en-Y gastric bypass. Am Surg 69:304–309 (discussion 309–310)Google Scholar
- 9.MBSAQIP MBSAQIP Participant Use Data File (PUF)Google Scholar
- 11.Fecso AB, Samuel T, Elnahas A, Sockalingam S, Jackson T, Quereshy F, Okrainec A (2018) Clinical indicators of postoperative bleeding in Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 28:52–55Google Scholar
- 12.Rondelli F, Bugiantella W, Vedovati MC, Mariani E, Balzarotti Canger RC, Federici S, Guerra A, Boni M (2017) Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy: a retrospective multicenter comparison between early and long-term post-operative outcomes. Int J Surg 37:36–41CrossRefGoogle Scholar
- 19.Silecchia G, Iossa A (2018) Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol 31:56–64Google Scholar