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The Long-Term Risk of Venous Thromboembolism Following Bariatric Surgery

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Abstract

Background

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality following bariatric surgery. The exact duration and magnitude of post-surgery risk for VTE, however, is unclear. We analyzed a large administrative database to determine the long-term risk and predictors for VTE in patients undergoing bariatric surgery.

Methods

A private insurance claims database was used to identify 17,434 patients who underwent bariatric surgery. Longitudinal data were available for each patient for up to 12 months post-surgery. We used logistic regression to identify independent predictors for VTE events.

Results

The incidence of VTE during the index surgical hospitalization was .88%. This cumulative rate rose to 2.17% at 1 month and 2.99% by 6 months post-surgery. Over 74% of VTE events occurred after discharge. Risk factors identified for VTE developing by 6 months post-surgery included male sex (odds ratio (OR) = 1.68; confidence limits (CL) = 1.37–2.07), age ≥ 55 years (OR = 2.18; CL = 1.56–3.03), smoking (OR = 1.86; CL = 1.06–3.27), and previous VTE (OR = 7.48; CL = 5.78–9.67). The laparoscopic adjustable gastric band was less likely to result in VTE compared to open or laparoscopic gastric bypass (OR = .31; CL = .13–.75).

Conclusions

The period of increased risk for VTE following bariatric surgery extends well beyond the initial hospital discharge and 30 days after surgery. The high frequency of VTE up to 6 months following bariatric surgery suggests that more aggressively extended prophylaxis should be considered in patients at higher risk for VTE.

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References

  1. Geerts WH, Bergquist D, Pineo GF, et al. Prevention of venous thromboembolism: ACCP evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:381S–453.

    Article  PubMed  CAS  Google Scholar 

  2. Heit J, Cohen A, Anderson FJ. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism events in the US. Blood. 2005;106:267A.

    Google Scholar 

  3. Acting Surgeon General Issues ‘Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism’. Office of the Surgeon General, U.S. Department of Health and Human Services <http:www.surgeongeneral.gov/news/pressreleases/pr20080915.html>.

  4. Qadan M, Tyson M, McCafferty MH, et al. Venous thromboembolism in elective operations: balancing the choices. Surgery. 2008;144:654–61.

    Article  PubMed  Google Scholar 

  5. Hamad GG, Choban PS. Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study. Obes Surg. 2005;15:1368–74.

    Article  PubMed  Google Scholar 

  6. Sapala JA, Wood MH, Schuhknecht MP, et al. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003;13:819–25.

    Article  PubMed  Google Scholar 

  7. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246:1002–7.

    Article  PubMed  Google Scholar 

  8. Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236:576–82.

    Article  PubMed  Google Scholar 

  9. Hutter MH, Randall S, Khuri SF, et al. Lararoscopic versus open gastric bypass for morbid obesity. Ann Surg. 2006;243:657–66.

    Article  PubMed  Google Scholar 

  10. Mukherjee D, Lidor AO, Chu KM, et al. Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg. 2008;12:2015–22.

    Article  PubMed  Google Scholar 

  11. Nguyen NT, Hinojosa MW, Fayad C, et al. Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg. 2007;246:1021–7.

    Article  PubMed  Google Scholar 

  12. Prystowsky JB, Morasch MD, Eskandari MK, et al. Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients. Surgery. 2005;138:759–65.

    Article  PubMed  Google Scholar 

  13. Encinosa WE, Bernard DM, Du D, et al. Recent improvements in bariatric surgery outcomes. Med Care. 2009;47:531–5.

    Article  PubMed  Google Scholar 

  14. Carmody BJ, Sugerman HJ, Kellum JM, et al. Pulmonary embolism complicating bariatric surgery: detailed ananysis of a single institution’s 24-year experience. J Am Coll Surg. 2006;203:831–7.

    Article  PubMed  Google Scholar 

  15. Abou-Nukta F, Alkhoury F, Arroyo K, et al. Clinical pulmonary embolus after gastric bypass surgery. Surg Obes Relat Dis. 2006;2:24–9.

    Article  PubMed  Google Scholar 

  16. Gonzalez R, Haines K, Nelson LG, et al. Predictive factors of thromboembolic events in patients undergoing roux-en-y gastric bypass. Surg Obes Relat Dis. 2006;2:30–6.

    Article  PubMed  Google Scholar 

  17. Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic roux-en-y gastric bypass surgery. Obes Surg. 2004;14:731–7.

    Article  PubMed  Google Scholar 

  18. Eriksson S, Backman L, Ljungstrom K. The incidence of clinical postoperative thrombosis after gastric surgery for obesity during 16 years. Obes Surg. 1997;7:332–5.

    Article  PubMed  CAS  Google Scholar 

  19. Raftopoulos I, Martindale C, Cronin A, et al. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc. 2008;22:2384–91.

    Article  PubMed  Google Scholar 

  20. Brasileiro AL, Miranda F, Ettinger JE, et al. Incidence of lower limbs deep vein thrombosis after open and laparoscopic gastric bypass: a prospective study. Obes Surg. 2008;18:52–7.

    Article  PubMed  Google Scholar 

  21. Westling A, Bergquist D, Bostrom A, et al. Incidence of deep venous thrombosis in patients undergoing obesity surgery. World J Surg. 2002;26:470–3.

    Article  PubMed  Google Scholar 

  22. Clinical issues committee of the American Society for Metabolic and Bariatric Surgery position statement. Prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2007;3:494–5.

    Article  Google Scholar 

  23. Barba CA, Harrington C, Loewen M. Status of venous thromboembolism prophylaxis among bariatric surgeons: have we changed our practice during the past decade? Surg Obes Relat Dis. 2009;5:352–6.

    Article  PubMed  Google Scholar 

  24. Bergquist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346:975–80.

    Article  Google Scholar 

  25. Gargiulo NJ, Veith FJ, Lipsitz EC, et al. The incidence of pulmonary embolism in open versus laparoscopic gastric bypass. Ann Vasc Surg. 2007;21:556–9.

    Article  PubMed  Google Scholar 

  26. Vaziri K, Bhanot P, Hungness ES, et al. Retrievable inferior vena cava filters in high-risk patients undergoing bariatric surgery. Surg Endosc. 2009;23(10):2203–7.

    Article  PubMed  Google Scholar 

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Acknowledgments

The dataset used in this study was originally created for a different research project on patterns of obesity care within selected BCBS plans. The previous research project (but not the current study) was funded by unrestricted research grants from Ethicon Endo-Surgery, Inc. (a Johnson & Johnson company), Pfizer, Inc. and GlaxoSmithKline. The data and database development support and guidance were provided by the BCBS Association, BCBS of Tennessee, BCBS of Hawaii, BCBS of Michigan, BCBS of North Carolina, Highmark, Inc. of Pennsylvania, Independence Blue Cross of Pennsylvania, Wellmark BCBS of Iowa, and Wellmark BCBS of South Dakota.

Funding/Support

Creation of the database was funded by Ethicon Endo-Surgery, Inc.; GlaxoSmithKline; and Pfizer, Inc. Data and support were provided by Blue Cross Blue Shield of Michigan and Highmark. Support was provided by the Blue Cross Blue Shield Association.

Role of the Sponsor

The supporting organizations were kept informed of the study’s progress and shared their expertise on certain aspects of the study. Also, preliminary findings were shared with them, and they were invited to review the manuscript. However, they did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation or approval of the manuscript.

Conflict of Interest

The following authors declare that they have no conflict of interest. Kimberley E. Steele, MD, Michael A. Schweitzer, MD, Gregory Prokopowicz, MD, Andrew D. Shore, PhD, Lisa C. B. Eaton, BA, Anne O. Lidor, MD, Martin A. Makary, MD, Jeanne Clark, Thomas H. Magnuson, MD.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kimberley Eden Steele, Michael A. Schweitzer, Lisa C. B. Eaton, Anne O. Lidor, Martin A. Makary & Thomas H. Magnuson

  2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Andrew D. Shore

  3. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gregory Prokopowicz & Jeanne Clark

  4. Department of Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA

    Kimberley Eden Steele

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  1. Kimberley Eden Steele
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  2. Michael A. Schweitzer
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Correspondence to Kimberley Eden Steele.

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Steele, K.E., Schweitzer, M.A., Prokopowicz, G. et al. The Long-Term Risk of Venous Thromboembolism Following Bariatric Surgery. OBES SURG 21, 1371–1376 (2011). https://doi.org/10.1007/s11695-011-0445-7

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