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Venous thromboembolism risk for the contemporary bariatric surgeon

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Abstract

Background

Postoperative venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are the leading causes of morbidity and mortality after bariatric surgery. Although several studies have examined VTE, few have examined risk factors separately for DVT and PE after contemporary bariatric surgery, including laparoscopic sleeve gastrectomy (LSG). Our objective was to define risk factors for DVT and PE independently for both LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB) patients using the largest validated bariatric surgery database.

Methods

The metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP) database was queried to identify patients who underwent LSG or LRYGB between January 2015 and December 2017. Perioperative data were compared using bivariate analysis. Risk of DVT and PE after LSG or LRYGB was determined using multivariable logistic regression analysis.

Results

During the study period, 369,032 bariatric cases (72% LSG, 28% LRYGB) were performed. The incidence of DVT was similar between LSG and LRYGB (0.2% vs. 0.2%, p = 0.96), while the incidence of PE was decreased for LSG compared to LRYGB (0.1% vs. 0.2%, p < 0.001). Operative length was associated with increased risk of postoperative DVT (OR 1.1, CI 1.01–1.30, p = 0.04) and postoperative PE (OR 1.4, CI 1.16–1.64, p < 0.001) after surgery. The largest independent risk factors for DVT were history of DVT (OR 6.2, CI 4.44–8.45, p < 0.001) and transfusion (OR 4.2, CI 2.48–6.63, p < 0.001). The largest independent risk factors for PE were transfusion (OR 5.0, CI 2.69–8.36, p < 0.001) and history of DVT (OR 2.8, CI 1.67–4.58, p < 0.001). LSG was associated with a decreased risk of PE compared to LRYGB (OR 0.7 CI 0.55–0.91, p = 0.01).

Conclusions

Prolonged operative length is associated with a higher risk of DVT and PE after either LSG or LRYGB. Transfusion and history of DVT are the largest risk factors for developing DVT and PE. There is a decreased risk of PE after LSG compared to LRYGB.

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Acknowledgements

We acknowledge the Center for Statistical Consulting at the University of California, Irvine for assistance in statistical analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, University of California Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868, USA

    Sahil Gambhir, Colette S. Inaba, Reza F. Alizadeh, Jeffry Nahmias, Marcelo Hinojosa, Brian R. Smith, Ninh T. Nguyen & Shaun Daly

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  1. Sahil Gambhir
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  2. Colette S. Inaba
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  3. Reza F. Alizadeh
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  7. Ninh T. Nguyen
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Corresponding author

Correspondence to Shaun Daly.

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Disclosures

Dr. Ninh T. Nguyen has received honorarium as a speaker for Covidien, Gore, Novadaq, and Olympus. Dr. Brian R. Smith has received honorarium as an educational consultant for STRYKER Endoscopy. Dr. Sahil Gambhir, Dr. Colette Inaba, Dr. Reza F. Alizadeh, Dr. Shaun Daly, Dr. Jeffry Nahmias, and Dr. Marcelo Hinojosa have no conflicts of interest or financial ties to disclose. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. All authors have approved the final article.

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Gambhir, S., Inaba, C.S., Alizadeh, R.F. et al. Venous thromboembolism risk for the contemporary bariatric surgeon. Surg Endosc 34, 3521–3526 (2020). https://doi.org/10.1007/s00464-019-07134-w

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  • DOI: https://doi.org/10.1007/s00464-019-07134-w

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