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Relationship of Hemorrhagic Complications With Perioperative Blood Pressure In Bariatric Surgery

Michael S Farrell, MD, MBS, Audrey Spencer, MD, Caitlin A Halbert, DO. 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 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) in 2016 at a single bariatric center of excellence.  A total of 8 patients were identified with perioperative HC. Each patient was matched 2:1 for procedure, body mass index, and medical comorbidities. Peak systolic, diastolic, and mean arterial pressures were compared between groups at time of admission, intraoperative, and during remainder of initial hospital stay. Welch’s T-tests were used for comparison between groups.

RESULTS: A total of 467 procedures were performed with 383 de novo SG, and 84 de novo GB.  Revisional bariatric cases were excluded from the study.  HC occurred in 8 (1.7%) total patients, 5 GS and 3 GB. Four patients required operative treatment for HC, 3 were treated laparoscopically and 1 required laparotomy. The mean diastolic pressures at time of arrival on day of surgery was higher in patients who develop HC (p=0.04) and mean peak diastolic pressure intraoperatively was lower in patients who develop HC (p=0.01). There was no statistical difference in peak systolic or mean arterial pressures throughout the hospital stay. 

CONCLUSIONS: Bariatric surgical patients with elevated preoperative diastolic blood pressures are at an increased risk of postoperative HC.  Additionally, decreased peak diastolic blood pressures may be an early indication of an HC in bariatric patients.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87482

Program Number: P547

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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