Michael Farrell, MD, MS, Zugui Zhang, PhD, Bayo Gbadebo, MBA, Caitlin Halbert, DO, MS. Christiana Care Health System
Introduction: The aim of this study is to identify potential risk factors or early indicators, specifically related to perioperative blood pressure, and its association with perioperative hemorrhage in the bariatric population. Laparoscopic bariatric surgery in the United States has been steadily increasing over the past several years. Between 2011 and 2015, the annual number of cases has increased by 24%. Although rare, hemorrhagic complications (HC) occur at a rate of 1-5% and can lead to significant morbidity and mortality. By identifying factors which may place a patient at a higher chance of HC, surgeons can potentially mitigate those risks. These modifications could reduce morbidity and limit the requirement of transfusions or reoperations.
Methods and Procedures: A retrospective case-control series was performed to include all patients who underwent either laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (GB) between 2015 and 2018 at a single bariatric center of excellence. Propensity matching was completed for age, gender, procedure, body mass index, and comorbidities including diabetes, hypertension, heart disease, anticoagulation/antiplatelet use and smoking status. Maximum and minimum systolic blood pressures (SBP), diastolic blood pressures (DBP), and mean arterial pressures (MAP) were compared between groups at time of admission, intraoperative, and during the remainder of initial hospital stay. Chi-square and odds ratio estimates were used to compare groups.
Result: A total of 1488 procedures were performed with 1203 de novo SG, and 285 de novo GB. Revisional and robotic bariatric cases were excluded from the study. HC occurred in 11 (0.74%) total patients, 8 GS and 3 GB. Three patients required transfusion transfusion of one unit packed red blood cells (pRBCs). Eight patients required at least 2 units pRBCs and all required operative treatment. There was no difference between the procedure performed and risk of developing HC (p-=0.96). Additionally, there was no difference between groups for preoperative or intraoperative blood pressure findings or postoperative DBP or MAP (p=0.3-0.95). After accounting for baseline hypertension, mean postoperative maximum (102 vs 146 mmHg) and minimum SBP (102 vs 112 mmHg) were significantly lower in patients who developed HC (p<0.001).
Conclusion: Relative decreased SBP in the immediate post-operative period may be an early sign of HC in bariatric patients. There was no associated increased risk of developing HC with preoperative or intraoperative blood pressure changes
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92295
Program Number: P081
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster