Maria S Altieri, MD, MS1, Jie Yang, PhD2, Chencan Zhu, MS2, Konstantinos Spaniolas, MD2, Mark Talamini, MD, MBA2, Aurora Pryor, MD2. 1Washington University School of Medicine, 2Stony Brook University Hospital
Introduction: Management of patients on chronic anti-coagulation (AC) in bariatric surgery may present a challenge, as there is a delicate balance between risks of bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The purpose of this study was to evaluate and compare rates of bleeding, thrombotic events, and outcomes of patients on pre-operative AC during bariatric surgery.
Methods: The MBSAQIP datasets for 2015 and 2016 was used to identify all patients undergoing Adjustable Gastric Banding (AGB), Sleeve Gastrectomy (SG) and Roux-en-Y Gastric bypass (RYGB). Patients’ demographics, surgery type, pre-operative BMI, operation length, ASA classifications, co-morbidities, and complications were examined. Clinical outcomes considered included length of stay, 30-day readmission, 30-days re-operations and interventions, peri-operative and 30-day death events, need for transfusion, PE, and DVT. Comparison in binary clinical outcome and LOS between patients with and without pre-op AC were carried out using multivariable logistic regression models and generalized linear regression model for a negative binomial distributed count outcome after adjusting for surgery type and other factors related to each outcome that were significant (p-value<0.1) based on univariate analysis, respectively. .
Results: There were 269,243 records extracted, as there were 7,187 AGB, 187,141 LSG, and 74,915 RYGB. There were 6,541 (2.43%) patients on pre-operative AC. Rates of transfusion, DVT, and PE were 0.67% (n=1795), 0.18% (n=474), and 0.11% (n=286). Following multivariable logistic regression, patients with pre-operative AC had higher risks of bleeding and DVT (OR 2.7, 95% CI 2.3-3.3, p-value <0.0001 and OR 2.8, 95% CI 1.9-4, p-value<0.0001 respectively). In addition, patients with pre-op AC had a higher risk of 30-day readmission (OR 2.1, 95% CI 1.9-2.3, p<0.0001)/re-operation (OR 1.5, 95% CI 1.2-1.7, p<0.0001)/ reintervention (OR 2.1, 95% CI 1.8-2.4, p<0.0001), mortality (OR 2.9, 95% CI 2.04-4.069, p<0.0001), and longer LOS (ratio 1.2, 95% CI 1.199-1.241, p<0.0001). There was no significant difference between the two groups in terms of risk of PE (OR 1.36, 95% CI 0.78-2.4, p-value=0.28).
Conclusion: Patients with pre-operative AC had worse outcomes in terms of bleeding, DVT, 30-day readmissions, reoperation, interventions, mortality, and longer LOS. Bariatric surgeons should be aware of the increased morbidity and mortality and care must be taken to improve outcomes through close attention to peri-operative AC protocols.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94494
Program Number: S055
Presentation Session: Bariatric I – Complications
Presentation Type: Podium