Skip to main content

Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery

Obesity Surgery volume 32, pages 1–8 (2022)Cite this article

Abstract

Purpose

Identifying the possible predictors of postoperative bleeding is advantageous to reduce healthcare costs and promote patients’ recovery. The aim of this study was to determine early postoperative bleeding predictors after bariatric surgery.

Materials and Methods

This retrospective study was conducted using data from 2260 patients who underwent bariatric surgery. We diagnosed early postoperative bleeding by the following symptoms: abdominal pain, hypotension, tachycardia, hematemesis, melena, decreased hemoglobin level, the need for at least two units of packed red blood cells (PRBCs) transfusion, and reoperation within the first 48 h after surgery.

Results

Our results showed the odds of early postoperative bleeding in laparoscopic Roux-en-Y gastric bypass (LRYGB) were higher than in laparoscopic sleeve gastrectomy (LSG) (OR 3.49, 95% CI 1.79 to 6.80). In addition, prior intragastric balloon (IGB) (OR 3.14, 95% CI 1.18 to 8.34) and oral non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) (OR 5.91, 95% CI 1.79 to 20.63) were positively associated with the occurrence of postoperative bleeding. In contrast, there was an inverse relationship between staple line oversewing and the odds of postoperative bleeding (OR 0.18, 95% CI 0.04 to 0.81). After stratification data based on the type of the surgery, the positive association between IGB and the odds of bleeding was constant in the LRYGB group. In the LSG group, use of non-aspirin NSAIDs was linked to a higher incidence of postoperative bleeding, while oversewing of the staple line lowered the incidence of this event.

Conclusions

Our results demonstrated a positive association between type of procedure, history of IGB, and oral non-aspirin NSIADs use, as well as an inverse relationship between staple line oversewing and the odds of bleeding after bariatric surgery.

Graphical Abstract

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Kumbhari V, Cummings DE, Kalloo AN, Schauer PR. AGA clinical practice update on evaluation and management of early complications after bariatric/metabolic surgery: expert review. Clin Gastroenterol Hepatol. 2021;19(8):1531–7.

    Article  Google Scholar 

  2. Sheka AC, Kizy S, Wirth K, Grams J, Leslie D, Ikramuddin S. Racial disparities in perioperative outcomes after bariatric surgery. Surg Obesity Relat Dis. 2019;15(5):786–93.

    Article  Google Scholar 

  3. Nijland LMG, de Castro SMM, van Veen RN. Risk factors associated with prolonged hospital stay and readmission in patients after primary bariatric surgery. Obes Surg. 2020;30(6):2395–402.

    Article  CAS  Google Scholar 

  4. Khalaj A, Tasdighi E, Hosseinpanah F, Mahdavi M, Valizadeh M, Farahmand E, et al. Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS). BMC Surg. 2020;20(1):160.

    Article  Google Scholar 

  5. Nielsen HJ, Nedrebø BG, Fosså A, Andersen JR, Assmus J, Dagsland VH, et al. Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy. Int J Obesity (2005). 2022;46(4):739–49.

  6. Vilallonga R, Hidalgo M, Garcia Ruiz de Gordejuela A, Caubet E, Gonzalez O, Ciudin A, et al. Operative and postoperative complications of laparoscopic sleeve gastrectomy in super and nonsuper obese patients: a center of excellence experience comparative study. J Laparoendosc Adv Surg Tech - A. 2020;30(5):501–7.

  7. Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, et al. Effect of Laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.

    Article  Google Scholar 

  8. Salminen P, Helmiö M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241–54.

    Article  Google Scholar 

  9. De Angelis F, Abdelgawad M, Rizzello M, Mattia C, Silecchia G. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc. 2017;31(9):3547–51.

    Article  Google Scholar 

  10. Fecso AB, Samuel T, Elnahas A, Sockalingam S, Jackson T, Quereshy F, et al. Clinical indicators of postoperative bleeding in bariatric surgery. Surg Laparoscop Endoscop Percutaneous Techniques. 2018;28(1):52–5.

    Article  Google Scholar 

  11. Goel R, Nasta AM, Goel M, Prasad A, Jammu G, Fobi M, et al. Complications after bariatric surgery: a multicentric study of 11,568 patients from Indian bariatric surgery outcomes reporting group. J Minim Access Surg. 2021;17(2):213–20.

    Article  Google Scholar 

  12. Amirian H, Torquati A, Omotosho P. Racial disparity in 30-day outcomes of metabolic and bariatric surgery. Obes Surg. 2020;30(3):1011–20.

    Article  Google Scholar 

  13. Melissas J, Stavroulakis K, Tzikoulis V, Peristeri A, Papadakis JA, Pazouki A, et al. Sleeve gastrectomy vs Roux-en-Y gastric bypass. Data from IFSO-European Chapter Center of Excellence Program. Obesity Surg. 2017;27(4):847–55.

  14. Mocanu V, Dang J, Ladak F, Switzer N, Birch DW, Karmali S. Predictors and outcomes of bleed after sleeve gastrectomy: an analysis of the MBSAQIP data registry. Surg Obesity Relat Dis. 2019;15(10):1675–81.

    Article  Google Scholar 

  15. Zafar SN, Miller K, Felton J, Wise ES, Kligman M. Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences. Surg Endosc. 2019;33(1):272–80.

    Article  Google Scholar 

  16. Leeman M, Huisbrink J, Wijnand JMA, Biter LU, Verbrugge SJC, Dunkelgrun M, et al. Trial protocol: preoperative administration of tranexamic acid in sleeve gastrectomy (PATAS) to reduce haemorrhage rates. A randomised controlled trial. BMJ Open 2020;10(2):e034572.

  17. Toolabi K, Golzarand M, Farid R. Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of efficacy and safety: a comparative study during 11-year experience. Obes Surg. 2021;31(6):2489–96.

    Article  Google Scholar 

  18. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  Google Scholar 

  19. Patrzyk M, Sonke J, Glitsch A, Kessler R, Steveling A, Lünse S, et al. Gastric balloon implantation as part of morbid adiposity therapy changes the structure of the stomach wall. Visceral Med. 2021;37(5):418–25.

    Article  Google Scholar 

  20. Dang JT, Switzer NJ, Sun WYL, Raghavji F, Birch DW, Karmali S. Evaluating the safety of intragastric balloon: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obesity Relat Dis. 2018;14(9):1340–7.

    Article  Google Scholar 

  21. Susmallian S, Danoch R, Raskin B, Raziel A, Barnea R, Dvora P. Assessing bleeding risk in bariatric surgeries: a retrospective analysis study. Digest Dis (Basel, Switzerland). 2020;38(6):449–57.

    Article  Google Scholar 

  22. Castro A, Cassinello N, Alfonso R, Ortega J. Preoperative risk factors for early hemorrhagic complications in bariatric surgery: a case-control study. Surg Endosc. 2021;36(1):430–4.

    Article  Google Scholar 

  23. Janik MR, Walędziak M, Brągoszewski J, Kwiatkowski A, Paśnik K. Prediction model for hemorrhagic complications after laparoscopic sleeve gastrectomy: development of SLEEVE BLEED calculator. Obes Surg. 2017;27(4):968–72.

    Article  Google Scholar 

  24. Javanainen MH, Scheinin T, Mustonen H, Leivonen M. Retrospective analysis of 3 different antithrombotic prophylaxis regimens in bariatric surgery. Surg Obesity Relat Dis. 2016;12(3):675–80.

    Article  Google Scholar 

  25. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obesity Relat Dis. 2014;10(4):713–23.

    Article  Google Scholar 

  26. Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc. 2020;34(1):396–407.

    Article  Google Scholar 

  27. Demeusy A, Sill A, Averbach A. Current role of staple line reinforcement in 30-day outcomes of primary laparoscopic sleeve gastrectomy: an analysis of MBSAQIP data, 2015–2016 PUF. Surg Obesity Relat Dis. 2018;14(10):1454–61.

    Article  Google Scholar 

  28. Özgen G, Çalıkoğlu İ, Acunaş B, Yerdel MA. Staple-line reinforcement using barbed sutures in 1008 sleeve gastrectomies. Langenbeck’s Arch Surg. 2021;406(5):1683–90.

    Article  Google Scholar 

  29. Banescu B, Balescu I, Copaescu C. Postoperative bleeding risk after sleeve gastrectomy. a two techniques of stapled line reinforcement comparative study in 4996 patients. Chirurgia (Bucharest, Romania: 1990). 2019;114(6):693–703.

  30. Taha O, Abdelaal M, Talaat M, Abozeid M. A randomized comparison between staple-line oversewing versus no reinforcement during laparoscopic vertical sleeve gastrectomy. Obes Surg. 2018;28(1):218–25.

    Article  Google Scholar 

  31. Wu C, Wang FG, Yan WM, Yan M, Song MM. Is there necessity for oversewing the staple line during laparoscopic sleeve gastrectomy? An updated systematic review and meta-analysis of randomized controlled trials. J Investig Surg. 2020;33(9):839–50.

    Article  Google Scholar 

  32. Borjas G, Gonzalez M, Maldonado A, Urdaneta A, Ramos E. Oversewing staple line of the gastric remnant in gastric bypass reduces postoperative bleeding. Annals Med Surg. 2021;67:102534.

  33. Mojkowska A, Gazdzinski S, Fraczek M, Wyleżoł M. Gastric ulcer hemorrhage - a potential life-threatening complication of intragastric balloon treatment of obesity. Obes Facts. 2017;10(2):153–9.

    Article  Google Scholar 

  34. Reed L, Edriss H, Nugent K. Gastric ulceration and bleeding with hemodynamic instability caused by an intragastric balloon for weight loss. Clin Endoscop. 2018;51(6):584–6.

    Article  Google Scholar 

  35. Tate CM, Geliebter A. Intragastric balloon treatment for obesity: FDA safety updates. Adv Ther. 2018;35(1):1–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 1985717413, Tehran, Iran

    Mahdieh Golzarand

  2. Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, 1419733141, Tehran, Iran

    Karamollah Toolabi

  3. West Nikan Hospital, 1985717413, Theran, Iran

    Reza Parsaei

Authors
  1. Mahdieh Golzarand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karamollah Toolabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reza Parsaei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s design, as well as data collection, analysis, and interpretation. The manuscript was prepared by all of the authors, and they all approved the final version. Furthermore, all authors accept responsibility for all parts of the work, including ensuring that any concerns about its accuracy or integrity are thoroughly investigated and resolved.

Corresponding author

Correspondence to Karamollah Toolabi.

Ethics declarations

Ethical Approval

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

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

• Prior IBG, use of non-aspirin NSAIDs, and non-staple line oversewing were determined as predictors of bleeding in patients who have undergone bariatric surgery.

• In the LRYGB group, prior IGB history was associated with a higher incidence of postoperative bleeding.

• In the LSG group, there was an inverse association between oversewing of the staple line and the odds of early postoperative bleeding but a positive association between use of non-aspirin NSIADs and this event.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Golzarand, M., Toolabi, K. & Parsaei, R. Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery. OBES SURG 32, 1–8 (2022). https://doi.org/10.1007/s11695-022-06059-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-022-06059-z

Keywords

  • Hemorrhage
  • Sleeve gastrectomy
  • Gastric bypass
  • Retrospective cohort