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Sleeve Gastrectomy Postoperative Hemorrhage is Linked to Type-2 Diabetes and Not to Surgical Technique

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Abstract

Background

The degree, prevalence, and risk factors linked to sleeve gastrectomy (SG) postoperative hemorrhage (POH) have not been fully defined.

Methods

An analysis was conducted on a prospectively collected database of 394 consecutive primary SGs performed in a single practice from January 2014 to December 2015. End points: (1) acute POH, defined by red blood cell (RBC) transfusion and/or re-exploration; (2) subclinical POH, defined by postoperative hemoglobin drop (HgbD) >one standard deviation above mean. Variables tested included three surgical techniques: normal stapling (n = 137), “tight” stapling, (n = 142) and oversewing, (n = 115); age; gender; body mass index (BMI); co-morbidities; and elevated postoperative systolic blood pressure.

Results

Acute POH occurred in 11/394 patients (2.8%) and subclinical POH (HgbD > 2.2 g/dL) was detected in 27/312 (7.7%) of patients with available HgbD data. Acute POH patients had a mean HgbD of 5.43 ± 1.40 g/dl (p < 0.001) reflecting approximately 38.6% ± 10.0% of total blood volume. No difference in prevalence of POH was observed for the different surgical techniques. Compared with non-bleeders (n = 312), acute and subclinical POH patients (n = 38) had 52.6 vs. 27.2% prevalence type-2 diabetes (T2D) and 60.5 vs. 40.1% prevalence of dyslipidemia and higher mean preoperative hemoglobin 14.3 ± 11 vs.13.5 ± 1.2 (p < 0.05 for all). On regression analysis, only T2D (OR 2.6; 95% CI 1.2–5.6) and higher level of preoperative hemoglobin (OR 1.7; 95% CI 1.3–2.4) were independent risk factors for POH.

Conclusion

In this study, acute and subclinical POH were primarily linked to T2D and not to surgical techniques. Special consideration is recommended for patients with T2D undergoing SG.

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Authors and Affiliations

  1. Bariatric center, Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel

    Hadar Spivak, Carmil Azran & Galina Lidermann

  2. Coagulation Unit, Institute of Hematology, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Galia Spectre

  3. Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel

    Orit Blumenfeld

Authors
  1. Hadar Spivak
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  2. Carmil Azran
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  3. Galia Spectre
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  4. Galina Lidermann
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  5. Orit Blumenfeld
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Correspondence to Hadar Spivak.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Spivak, H., Azran, C., Spectre, G. et al. Sleeve Gastrectomy Postoperative Hemorrhage is Linked to Type-2 Diabetes and Not to Surgical Technique. OBES SURG 27, 2927–2932 (2017). https://doi.org/10.1007/s11695-017-2731-5

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  • DOI: https://doi.org/10.1007/s11695-017-2731-5

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