Thromboembolic Events in Bariatric Surgery: The Cleveland Clinic Experience

Mohammad H Jamal, MD, MEd, FRCSC, Hideharu Shimizu, MD, Stacy Brethauer, MD, FACS, Mathew Kroh, MD, FACS, Biban Chand, MD, FACS, Philip Schauer, MD, FACS. Cleveland Clinic.

Introduction

The risk of venous thromboembolic (VTE) events is increased in patients undergoing bariatric surgery. Population studies examining VTE rates after bariatric surgery often lack details and uniformity regarding the prophylactic regimens used. The aim of this study is to determine the incidence of VTE in patients undergoing laparoscopic bariatric surgery from two centers within the same health care system.

Methods
Database searches from Cleveland Clinic bariatric surgery programs in Cleveland, OH, and Weston, FL were conducted from 01/05 to 01/13. Mechanical and chemical prophylaxis (Lovenox BID) were given to all patients and extended chemoprophylaxis prescribed to patients at higher risk for VTE. Data on age, gender, body mass index (BMI), interval between procedure and VTE, inpatient versus outpatient status, anticoagulation prophylaxis, type of surgery and mortality were collected.

Results
A total of 4,293 patients were identified. VTE events were identified in 57 patients (1.3%). Pulmonary embolism (PE) was identified in 39 patients (0.9%) and 15 of these patients had negative duplex studies of the lower extremities. Deep venous thrombosis only was identified in 18 patients (0.4%). Six patients underwent an open procedure (10.5%). VTE rates for gastric bypass (n=2851), sleeve gastrectomy (n=701), and revisional procedures (n=159) were 1.1%, 1.85%, AND 0.6%, respectively. Eight patients had VTE diagnosed during their inpatient stay. The mean time to VTE diagnosis after surgery was 24 days (range 2-124). . Seventeen patients who developed VTE had been prescribed extended prophylaxis for 2-4 weeks after discharge. There was only one VTE related mortality from PE reported in this cohort (0.02%).

Univariate and multivariate analysis revealed age, BMI, open and revisional surgery as predictive of VTE (p<0.05).

Conclusion
The risk of VTE among morbidly obese patients undergoing bariatric surgery is persistent despite use of laparoscopy and aggressive prophylactic anticoagulation policy. Patients with advanced age, higher BMI and those undergoing open or revisional surgery should be considered candidates for extended chemoprophylaxis.
 

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