Rajmohan Rammohan, MD, Morris Sasson, MD, Terry King, MD, MBA, FACS, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS,Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
Background: Postoperative pulmonary embolism (PE) remains one of the leading cause of morbidity and mortality after bariatric surgery. The use of preoperative inferior vena cava (IVC) filter has not been proven to be beneficial. We present our experience with preoperative IVC filter use.
Objective: To analyzethe effect IVC filter in patients following bariatric surgery while controlling for differences in the baseline patient characteristics and risk factors.
Methods: All the patients who underwent Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), Laparoscopic Sleeve gastrectomy (LSG)and revision procedures (REV) between 2010 and 2015were retrospectively reviewed. The data regarding patient’s demographics, BMI,Pulmonary embolism, Deep Vein thrombosis (DVT) and IVC filter placement were documented. Cases are matched to controls using propensity score matching. Different matching schemes were considered, namely matching ratios from 1-1 up to 4-1. Once the base line characteristics were matched Univariate logistic regressions was used to compare between patients with IVC filter and no IVC filter who underwent bariatric procedures.
Results: A total of 1380 patient underwent laparoscopic procedures between2010 and 2015,of which 51patients(3%) had preoperative IVC filter.There were no significant differences in the baseline characteristics among the51 patients with IVC filter and in 51 matched control patients. There were twenty four female patients (47%) with IVC filter against eighteen female patients (35%) without IVC filter.The average age in the cohort is48.6±13.6 and the average BMI was 52.8±14.9. There was significant difference in the Length of stay (LOS) between IVC filter vs no IVC filter (4.4±4.2 vs 2 ± 3, p< 0.01).The Outcome of PE and DVT in both groups using 4:1 match showed no significance(0%vs1%;Odds Ratio(OR),16.36; p= 0.1) & (0%vs1%,OR, 16.24,P= 0.1)
Conclusion: According to our data there is insufficient evidence to support the use of perioperative IVC filter.These results are in agreement with the current evidence in the literature
| VARIABLES | ODDS RATIO | P-VALUE |
|---|---|---|
| Hypertension | 0.25 | <0.001 |
| obstructive sleep apnea | 0.47 | 0.03 |
| Coronary artery disease | 1.33 | 0.62 |
| Diabetes | 6.81 | 0.003 |
| Hypercholesterolemia | 0.37 | 0.13 |
| Smoking | 0.68 | 0.29 |
| Length ofS tay | 1.24 | <0.001 |
| DVT(4:1match) | 16.24 | 0.1 |
| PE(4:1match) | 16.36 | 0.1 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79530
Program Number: P632
Presentation Session: Poster (Non CME)
Presentation Type: Poster
