Advertisement

Surgical Endoscopy

, Volume 33, Issue 1, pp 272–280 | Cite as

Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences

  • Syed Nabeel Zafar
  • Kaylie Miller
  • Jessica Felton
  • Eric S. Wise
  • Mark KligmanEmail author
2018 SAGES Oral
  • 161 Downloads

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Bariatric surgery Complications Weight loss surgery Outcomes 

Notes

Acknowledgements

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

Disclosures

Syed Nabeel Zafar, Jessica Felton, Kaylie Miller, Eric S. Wise, and Mark Kligman have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Livingston EH (2010) The incidence of bariatric surgery has plateaued in the U.S. Am J Surg 200:378–385CrossRefGoogle Scholar
  2. 2.
    English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM (2018) American society for metabolic and bariatric surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis 14:259–263CrossRefGoogle Scholar
  3. 3.
    Rosenthal RJ, Szomstein S, Kennedy CI, Soto FC, Zundel N (2006) Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. Obes Surg 16:119–124CrossRefGoogle Scholar
  4. 4.
    Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN (2014) Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg 208:903–910 (discussion 909–910)CrossRefGoogle Scholar
  5. 5.
    Weiner RA, El-Sayes IA, Theodoridou S, Weiner SR, Scheffel O (2013) Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg 23:2004–2012CrossRefGoogle Scholar
  6. 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
  7. 7.
    Rabl C, Peeva S, Prado K, James AW, Rogers SJ, Posselt A, Campos GM (2011) Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg 21:413–420CrossRefGoogle Scholar
  8. 8.
    Spaw AT, Husted JD (2005) Bleeding after laparoscopic gastric bypass: case report and literature review. Surg Obes Relat Dis 1:99–103CrossRefGoogle Scholar
  9. 9.
    MBSAQIP MBSAQIP Participant Use Data File (PUF)Google Scholar
  10. 10.
    Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S (1997) A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 16:965–980CrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Heneghan HM, Meron-Eldar S, Yenumula P, Rogula T, Brethauer SA, Schauer PR (2012) Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese. Surg Obes Relat Dis 8:729–735CrossRefGoogle Scholar
  14. 14.
    Dick A, Byrne TK, Baker M, Budak A, Morgan K (2010) Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe? Surg Obes Relat Dis 6:643–647CrossRefGoogle Scholar
  15. 15.
    Garg T, Rosas U, Rivas H, Azagury D, Morton JM (2016) National prevalence, causes, and risk factors for bariatric surgery readmissions. Am J Surg 212:76–80CrossRefGoogle Scholar
  16. 16.
    Vonlanthen R, Slankamenac K, Breitenstein S, Puhan MA, Muller MK, Hahnloser D, Hauri D, Graf R, Clavien PA (2011) The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg 254:907–913CrossRefGoogle Scholar
  17. 17.
    Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB (2017) Hospital quality and medicare expenditures for bariatric surgery in the United States. Ann Surg 266:105–110CrossRefGoogle Scholar
  18. 18.
    Sharma G, Hanipah ZN, Aminian A, Punchai S, Bucak E, Schauer PR, Brethauer SA (2018) Bariatric surgery in patients on chronic anticoagulation therapy. Obes Surg.  https://doi.org/10.1007/s11695-018-3120-4 Google Scholar
  19. 19.
    Silecchia G, Iossa A (2018) Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol 31:56–64Google Scholar
  20. 20.
    Nguyen NT, Longoria M, Welbourne S, Sabio A, Wilson SE (2005) Glycolide copolymer staple-line reinforcement reduces staple site bleeding during laparoscopic gastric bypass: a prospective randomized trial. Arch Surg 140:773–778CrossRefGoogle Scholar
  21. 21.
    Shikora SA, Kim JJ, Tarnoff ME (2003) Reinforcing gastric staple-lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y gastric bypass. Obes Surg 13:37–44CrossRefGoogle Scholar
  22. 22.
    Sharma G, Strong AT, Tu C, Brethauer SA, Schauer PR, Aminian A (2018) Robotic platform for gastric bypass is associated with more resource utilization: an analysis of MBSAQIP dataset. Surg Obes Relat Dis 14:304–310CrossRefGoogle Scholar
  23. 23.
    Celio AC, Kasten KR, Schwoerer A, Pories WJ, Spaniolas K (2017) Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience. Surg Obes Relat Dis 13:1847–1852CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.School of MedicineUniversity of MarylandBaltimoreUSA
  3. 3.Center for Weight Management & WellnessUniversity of Maryland Medical CenterBaltimoreUSA

Personalised recommendations