Valentin Mocanu1, Jerry Dang1, Daniel Skubleny1, Noah Switzer2, Daniel Birch1, Shahzeer Karmali1. 1University of Alberta, 2The Ohio State University
BACKGROUND: The purpose of this study is to examine predictors of and outcomes associated with postoperative bleeding in patients undergoing laparoscopic sleeve gastrectomy (SG) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) data registry.
Bleeding following SG is a common complication associated with significant morbidity and a drastic increase in healthcare resources. Multiple strategies have been developed to minimize bleeding including varying bougie size, staple line reinforcement, and intra-operative tranexamic acid. These techniques, however, have been implemented without a clear understanding of the pre-, intra-, and post-operative predictors of bleeding in patients undergoing sleeve gastrectomy.
METHODS AND PROCEDURES: We identified all MBSAQIP patients who underwent SG in 2015 and 2016. Primary outcomes of interest include identifying the prevalence, impact, and predictors of bleeding in SG patients. Our secondary outcomes of interest include characterizing overall complication rates in SG patients. Univariate analysis of pre-, intra-, and post-operative variables was performed using Chi-squared tests for categorical data and independent sample t-test for continuous data. A non-parsimonious multivariable logistic regression model was then developed to determine predictive factors for development of postoperative bleed.
RESULTS: A total of 175353 patients underwent laparoscopic SG from 2015 to 2016. The majority of patients were female (79.0%), with a mean age of 44.4 (SD 12.0) years and a mean BMI of 45.2 kg/m2(SD 7.9 kg/m2). A total of 4366 (2.5%) patients had a postoperative bleed associated with a mortality of 1.0%. The mean operative time was 74.0 min (SD 36.6 min) with a mean bougie size of 36.9 F (SD 2.9F), and a mean pylorus distance of 4.80 cm (SD 1.1 cm). Staple line reinforcement was used in 67.8% of patients while 22.4% were oversewn. Bleeds were associated with a statistically significant increase in all complication rates. Multivariable logistic regression analysis revealed the following independent predictors of leak: bougie size, BMI, female, chronic steroids, dialysis, prior history MI, ASA, GERD, prior cardiac surgery, hypertension, prior DVT, renal insufficiency, therapeutic anticoagulation, diabetes, functional status, COPD, sleep apnea, and operating time.
CONCLUSION: Overall bleed rate following SG was 2.5% with bleed significantly increasing all other complications, readmission and reoperation rates and mortality at 30 days. Despite adoption of novel operative techniques to minimize bleed rates, none were protective after adjusting for confounders. Preoperative optimization of patient comorbidities prior to surgery may therefore have the greatest role in reduce bleeding after SG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95773
Program Number: P152
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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