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- Title
Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures.
- Authors
Altieri, Maria S.; Spaniolas, Konstantinos; Bates, Andrew T.; Docimo, Salvatore; Talamini, Mark; Pryor, Aurora D.; Yang, Jie; Hajagos, Janos; Park, Jihye; Gasparis, Antonios P.; Shroyer, A. Laurie
- Abstract
<bold>Background: </bold>Studies examining utilization and impact of venous thromboembolism (VTE) chemoprophylaxis for patients undergoing bariatric surgery are limited. Determination of the optimal prophylactic regimen to minimize complications is crucial.<bold>Methods: </bold>The Cerner Health Facts database from 2003 to 2013 was queried using ICD-9 codes to identify patients undergoing laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB). VTE chemoprophylaxis regimens were divided into pre-operative alone (PreP), post-operative alone (PostP), both pre-operative and post-operative (PPP), or no prophylaxis (NP). Specific chemoprophylaxis agents were compared. Comparisons in inpatient clinical outcomes were based on univariate analysis and multivariable logistic regression when appropriate.<bold>Results: </bold>We identified 11,860 patients who underwent LSG and RYGB. 634 (5.35%) had PreP, 4593 (38.73%) had PostP, 2646 (22.31%) had PPP, and 3987 (33.62%) had NP. The overall rates of transfusion, DVT, and PE were 2.48, 0.27, and 0.18%, respectively. Patients without chemoprophylaxis had higher rate of DVT compared to any chemoprophylaxis (0.58 vs 0.11%, p < 0.0001), without any significant difference in PE rate. Patients with pre-operative chemoprophylaxis were more likely to receive transfusion compared to patients with post-operative prophylaxis alone (OR 1.98, 95% CI 1.28-3), without significant difference in having VTE. When examining heparin versus enoxaparin versus mixed regimen in the PostP group, mixed regimen was associated with increased transfusion requirements (p < 0.001).<bold>Conclusions: </bold>Bariatric surgical VTE chemoprophylaxis utilization is inconsistent. In this study, post-operative VTE chemoprophylaxis was associated with decreased VTE events compared to NP, while minimizing bleeding compared to PreP. Mixed therapy using heparin and enoxaparin was associated with more bleeding.
- Subjects
BARIATRIC surgery; THROMBOEMBOLISM; SURGICAL complications; HEMORRHAGE; GASTRECTOMY
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2018, Vol 32, Issue 12, p4805
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-018-6231-z