Thromboembolic Events After Laparoscopic Gastric Bypass: Identification of High-risk Factors

C Gonczy, MD, V Advani, MD, S Markwell, MA, S Ahad, MD, I Hassan, MD. Southern Illinois University School of Medicine

Introduction: In-hospital prophylaxis against thromboembolic events (TE) is considered routine for patients after laparoscopic roux-en-Y gastric bypass surgery (LGB) for morbid obesity. However, there is a paucity of data regarding the utility of extending prophylaxis beyond discharge. Utilizing the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database, we analyzed patients undergoing LGB to determine the incidence of pre- and post-discharge TE and associated risk factors.
Methods: Patients undergoing LGB between 2005-2009, were identified from the public use file of the ACS-NSQIP database using the Current Procedural Terminology code for LGB. Univariate comparison and regression analysis of demographics and comorbidities of patients with and without TE were performed to determine independent risk factors for the development of TE.
Results: During the study period, 28,427 patients underwent LGB, of whom 123 (0.43%) developed a TE within 30 days of surgery. Seventy-seven percent of the pulmonary embolisms and 82% of the deep venous thromboses were diagnosed after discharge. On regression analysis several patient characteristics, medical comorbidities and postoperative complications were independently associated with increased risk of TE. (Table) 
Conclusion: The 30-day incidence of thromboembolic events after LGB in ACS-NSQIP hospitals is low, although the majority of these events occur following discharge. Certain patients are at higher risk for TE, and may represent a cohort that would benefit from extended post-operative prophylaxis.
 

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