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Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients

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Abstract

Introduction

Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended.

Methods

Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge.

Results

During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE.

Conclusion

Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.

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Authors and Affiliations

  1. Division of General, Thoracic and Vascular Surgery, Bariatric & Metabolic Institute, Surgery Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

    Abdelrahman A. Nimeri, Jejomar Bautista, Maha Ibrahim, Ruby Philip, Talat Al Shaban & Ahmed Maasher

  2. Abu Dhabi ACGME-I Accredited Surgery Residency Program, Abu Dhabi, United Arab Emirates

    Talat Al Shaban, Ahmed Maasher & Ajda Altinoz

Authors
  1. Abdelrahman A. Nimeri
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  2. Jejomar Bautista
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  3. Maha Ibrahim
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  4. Ruby Philip
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  5. Talat Al Shaban
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  6. Ahmed Maasher
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  7. Ajda Altinoz
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Corresponding author

Correspondence to Abdelrahman A. Nimeri.

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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.

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.

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Nimeri, A.A., Bautista, J., Ibrahim, M. et al. Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients. OBES SURG 28, 541–547 (2018). https://doi.org/10.1007/s11695-017-2909-x

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  • DOI: https://doi.org/10.1007/s11695-017-2909-x

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