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Erschienen in: Surgical Endoscopy 9/2020

15.10.2019 | 2019 SAGES Oral

Preoperative anticoagulation in patients undergoing bariatric surgery is associated with worse outcomes

verfasst von: Maria S. Altieri, Jie Yang, Chencan Zhu, L. Konstantinos Spaniolas, Mark A. Talamini, Aurora D. Pryor

Erschienen in: Surgical Endoscopy | Ausgabe 9/2020

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Abstract

Introduction

Management of patients on chronic anticoagulation (AC) in bariatric surgery may present a challenge, as there is a delicate balance between risks of bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The purpose of this study was to evaluate and compare rates of bleeding, thrombotic events, and outcomes of patients on preoperative AC during bariatric surgery.

Methods

The MBSAQIP data sets for 2015 and 2016 was used to identify all patients undergoing adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB). Clinical outcomes included length of stay, 30-day readmission, 30-day reoperations and interventions, perioperative and 30-day death events, need for transfusion, PE, and DVT. Following univariate analysis, multivariable logistic regression models and generalized linear regression model for a negative binomial distributed count outcomes were used after adjusting for surgery type and other factors related to each outcome.

Results

There were 269,243 records extracted, as there were 6541 (2.43%) patients on preoperative AC. Rates of transfusion, DVT, and PE were 0.67%, 0.18%, and 0.11%. Following multivariable logistic regression, patients with preoperative AC had higher risks of bleeding and DVT (OR 2.7, 95% CI 2.3–3.3, p-value < 0.0001 and OR 2.8, 95% CI 1.9–4, p-value < 0.0001, respectively). In addition, patients with pre-op AC had a higher risk of 30-day readmission (OR 2.1, 95% CI 1.9–2.3, p < 0.0001)/reoperation (OR 1.5, 95% CI 1.2–1.7, p < 0.0001)/reintervention (OR 2.1, 95% CI 1.8–2.4, p < 0.0001), mortality (OR 2.9, 95% CI 2.04–4.069, p < 0.0001), and longer LOS (ratio 1.2, 95% CI 1.199–1.241, p < 0.0001).

Conclusion

Patients with preoperative AC had worse postoperative outcomes. Bariatric surgeons should be aware of the increased morbidity and mortality, and care must be taken to improve outcomes through close attention to postoperative AC protocols in this group of patients.
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Metadaten
Titel
Preoperative anticoagulation in patients undergoing bariatric surgery is associated with worse outcomes
verfasst von
Maria S. Altieri
Jie Yang
Chencan Zhu
L. Konstantinos Spaniolas
Mark A. Talamini
Aurora D. Pryor
Publikationsdatum
15.10.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 9/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07191-1

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