Sn Zafar, MD, MPH, E S Wise, MD, M Kligman, MD. University of Maryland Medical Center
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a very common, safe and effective bariatric procedure worldwide. Postoperative bleeding represents a significant complication. Using a comprehensive national database, we aimed to determine the incidence, outcomes and predictors of postoperative bleeding after LRYGB.
Methods: LRYGB patients included in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset were identified. Patients at extremes of ages (<10 or >80 years), mini gastric bypasses, gastric plications and natural orifice operations were excluded. Postoperative bleeding was defined as any hemorrhage requiring a blood transfusion within 72 hours or requiring an operative or procedural intervention for ‘bleeding’. Preoperative and intraoperative factors were tested for associations with bleeding using univariable and multivariable logistic regression analysis. Outcomes of length of stay, in-hospital mortality, 30-day mortality, discharge disposition and 30-day complications among patients with and without postoperative bleeding were compared using multivariable regression.
Results: In the 43,280 LRYGB patients included in this analysis, postoperative bleeding occurred in 652 (1.51%) patients. Of these, 165 (25.3%) underwent a re-operation and 97 (14.9%) underwent an unplanned endoscopy for ‘bleeding’. Patients received a mean of 2.6 units of blood (range 1 to 13 units). Postoperative bleeding was associated with a longer median postoperative length of stay (4 versus 2 days), higher in-hospital mortality (1.23% versus 0.04%), higher 30 day mortality (1.38% versus 0.15%), discharge to an extended-care facility (3.88% versus 0.6%), and higher rates of major complications including acute renal failure (2.45% versus 0.12%), cardiac arrest (1.38% versus 0.06%), myocardial infraction (1.07% versus 0.04%), pneumonia (1.84% versus 0.41%), and pulmonary embolism (1.53% versus 0.15%) (all P<0.05). Independent predictors of postoperative bleeding included male gender (odds ratio [OR] 1.32, 95% confidence interval [CI] = 1.05-1.64), history of renal insufficiency (OR=2.81, 95% CI= 1.59-4.99), preoperative therapeutic anticoagulation (OR 2.43, 95% CI= 1.68-3.52), and revisional surgery (OR=1.49, 95% CI= 1.11-2.06). Intraoperative factors included conversions (OR = 3.28, 95%CI = 1.54-6.96), drain placement (OR = 1.40, 95% CI=1.18-1.66) and prolonged operative times (OR= 1.33, 95% CI = 1.03-1.71). Robotic approaches resulted in independently lower postoperative bleeding rates (OR=0.49, 95%CI= 0.32-0.76).
Conclusions: Postoperative bleeding occurs in 1.5% of patients undergoing a LRYGB and is associated with significantly increased morbidity and mortality. We have identified patient and operative factors that are independently associated with postoperative bleeding. This study provides the largest characterization of post-LRYGB bleeding to date.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88268
Program Number: S022
Presentation Session: Bariatrics 1 Session
Presentation Type: Podium