Abstract
Background
Postoperative hemorrhage is a rare complication in bariatric surgery. We aim to determine if differences in blood pressure or perioperative medication administration contribute to postoperative bleeding in patients who were hemodynamically stable intraoperatively.
Methods
This was a retrospective case-control study of all bariatric surgery patients from 2014 to 2017 at a high volume academic center. We identified controls based on age, gender, ethnicity, type of procedure, and pre-operative blood pressure.
Results
Patients with postoperative hemorrhage had a significantly lower MAP during the portion of the surgery in which the abdominal contents were inspected for leaks and bleeds. The timing of enoxaparin or ketorolac administration was not associated with bleeding.
Conclusion
Blood pressure lability, but not enoxaparin or ketorolac administration, is associated with postoperative hemorrhage.
References
Perioperative safety in the longitudinal assessment of bariatric surgery. New England Med. 2009;361(5):445–54. doi: https://doi.org/10.1056/NEJMoa0901836.
Pannucci CJ, Wachtman CF, Dreszer G, et al. The effect of postoperative enoxaparin on risk for reoperative hematoma. Plast Reconstr Surg. 2012;129(1):160–8. https://doi.org/10.1097/PRS.0b013e318236215c.
Morton RP, Vandal AC. Postoperative systolic blood pressure as a risk factor for haematoma following thyroid surgery. Clin Otolaryngol. 2015;40(5):462–467. https://doi.org/10.1111/coa.12407
Basali A, Mascha EJ, Kalfas I, et al. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology. 2000;93(1):48–54.
Janik MR, Rogula T, Kowalewski P, et al. Case-control study of postoperative blood pressure in patients with hemorrhagic complications after laparoscopic sleeve gastrectomy and matched controls. Obes Surg. 2017;27(7):1849–53. https://doi.org/10.1007/s11695-017-2569-x.
Moulin PA, Dutour A, Ancel P, et al. Perioperative thromboprophylaxis in severely obese patients undergoing bariatric surgery: insights from a French national survey. Surg Obes Relat Dis. 2017;13(2):320–6. https://doi.org/10.1016/j.soard.2016.08.497.
Klein M, Stockel M, Rosenberg J, et al. Intraoperative ketorolac and bleeding after laparoscopic Roux-en-Y gastric by-pass surgery. Acta Chir Belg. 2012;112(5):369–73.
Javanainen MH, Scheinin T, Mustonen H, et al. Retrospective analysis of 3 different antithrombotic prophylaxis regimens in bariatric surgery. Surg Obes Relat Dis. 2016;12(3):675–80. https://doi.org/10.1016/j.soard.2015.12.017.
Levin MA, Fischer GW, Lin HM, et al. Intraoperative arterial blood pressure lability is associated with improved 30 day survival. Br J Anaesth. 2015;115(5):716–26. https://doi.org/10.1093/bja/aev293.
Acknowledgements
Lee D. Ying is supported through the Yale Medical Scientist Training Program and a National Research Service Award through the National Institute of Diabetes and Digestive and Kidney Diseases (NRSA: 1F30DK112569-01).
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The authors declare that they have no conflict of interest.
Ethical Statement
This was a retrospective study, which was approved by the Institutional Human Investigation Committee not required (ID: 2000021987) and was conducted in accordance with the ethical standards of this institution, the national research committee, as well as the 1964 Helsinki Declaration and its later amendments.
Informed Consent Statement
This was a retrospective study which was approved by the Institutional Human Investigation Committee and determined that formal consent was not required. The IRB protocol ID is 2000021987.
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Ying, L.D., Duffy, A.J., Roberts, K.E. et al. Intraoperative Blood Pressure Lability Is Associated with Postoperative Hemorrhage after Uncomplicated Bariatric Surgery. OBES SURG 29, 1990–1994 (2019). https://doi.org/10.1007/s11695-019-03839-y
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DOI: https://doi.org/10.1007/s11695-019-03839-y