Aimal Khan, MD, Katey Feng, MPH, Richard D Stahl, MD, Abhishek D Parmar, MD, MS, Jayleen M Grams, MD, PhD. University of Alabama at Birmingham
Introduction: Bleeding following bariatric surgery can be a life-threatening complication. Here, we aimed to evaluate risk factors and outcomes of patients with postoperative bleeding using a national database from accredited bariatric centers.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) databases for 2015-2016 were used to identify patients with postoperative bleeding following laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Patients undergoing emergency or revisional surgery or had their approach converted intraoperatively were excluded. Multivariate logistic regression was used to identify the risk factors for postoperative bleeding.
Results: A total of 326,841 patients underwent either SG (70%) or RYGB (30%). Of these, 1,592 (0.5%) had postsurgical bleeding. RYGB were more likely to have a bleeding complication than SG (AOR 2.7, 95% CI= 2.375-2.982, p< 0001). Other factors associated with increased risk of postoperative bleeding included preoperative therapeutic anticoagulation (AOR 3.6, 95% CI= 3.017-4.338, p< 0.0001), history of pulmonary thromboembolism (AOR 1.4, 95% CI= 1.047-1.849, p=0.0227) or deep venous thrombosis (AOR 1.3, 95% CI= 1.002-1.670, p= 0.0479), renal insufficiency (AOR 2.8, 95% CI= 2.030-3.801, p< 0.0001), hypertension (AOR 1.2, 95% CI= 1.028-1.287, p= 0.0147), diabetes (AOR 1.2, 95% CI= 1.086-1.355, p= 0.0006), gastroesophageal reflux disease (AOR 1.1, 95% CI= 1.028-1.265, p=0.0130), obstructive sleep apnea (AOR 1.3, 95% CI= 1.028-1.272, p= 0.0132), and male sex (AOR 1.6, 95% CI= 1.429-1.789, p< 0.0001). ASA class, anastomotic or staple line provocative testing, and placement of a surgical drain were not associated with postoperative bleeding. On subgroup analysis of SG patients, use of staple line reinforcement material (AOR 0.722, 95% CI= 0.612-0.852, p=0.0001), over-sewing of the staple line (AOR 0.791, 95% CI= 0.646-0.969, p=0.0234), and increased distance of the staple line from the pylorus (AOR 0.933, 95% CI= 0.878-0.991, p=0.0232) were all associated with decreased risk of postoperative bleeding. Larger sleeve bougie sizes were associated with increased risk of postoperative bleeding (AOR 1.031, 95% CI= 1.010-1.052, p=0.0037). Patients with postoperative bleeding had significantly higher rates of unplanned admission to the ICU (25.25% vs 0.82%, p<0.0001), increased length of stay (4.15 days vs 1.82 days, p<0.0001) and mortality (1.82% vs 0.11%, p<0.0001).
Conclusions: The overall rate of bleeding following index bariatric surgery is lower than previously thought. Numerous patient- and operation-specific risk factors for postoperative bleeding are identified and may be useful for improving risk stratification, patient counseling, and development of processes to reduce the risk of postoperative bleeding.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95380
Program Number: P187
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster