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



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.


Bariatric 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.


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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

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