Don't Fear the Bleed: Assessing Postoperative Bleeding Incidence After Instituting a Standardized Prophylactic Heparin Protocol in Bariatric Patients
Publication: Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 34, Issue Number 5
Abstract
Background: Bariatric surgery is a frequently performed procedure in the United States, accounting for ∼40,000 procedures annually. Patients undergoing bariatric surgery are at high risk for postoperative thrombosis, with a venous thromboembolism (VTE) rate of up to 6.4%. Despite this risk, there is a lack of guidelines recommending postoperative VTE prophylaxis and it is not routine practice at most hospitals. The postoperative bleeding rate after bariatric surgery is only 1.5%; however, the risk of bleeding may lead to hesitancy for more liberal VTE prophylaxis.
Methods: This is a retrospective analysis of bariatric surgeries at a single institution in 2019 and 2021. Data were obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and electronic medical record review for all patients undergoing sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or conversion to RYGB. The primary outcomes were composite bleeding events, which included postoperative transfusion, postoperative endoscopy or return to operating room (OR) (for bleeding), intra-abdominal hematoma, gastrointestinal (GI) bleeding, or incisional hematoma.
Results: There were a total of 2067 patients in the cohort, with 1043 surgeries in 2019 and 1024 surgeries in 2021. There was no difference between bleeding events after instituting a deep venous thrombosis (DVT) prophylaxis protocol in 2021 (27 versus 28 events, P = .76). There was no difference in individual bleeding events between 2019 and 2021. Additionally, there was no significant difference in the rate of VTE between 2019 and 2021 (2 versus 5 events, P = .28).
Conclusions: After instituting a standard protocol of prophylactic heparin postdischarge, we did not find an increased rate of bleeding events in patients undergoing bariatric surgery. Thus, surgeons can consider prescribing postdischarge chemical VTE prophylaxis without concern for bleeding.
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Information & Authors
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Published In
Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 34 • Issue Number 5 • May 2024
Pages: 401 - 406
PubMed: 38657113
Copyright
Copyright 2024, Mary Ann Liebert, Inc., publishers.
History
Published online: 24 May 2024
Published in print: May 2024
Published ahead of print: 24 April 2024
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Authors
Authors' Contributions
Study design was done by D.C. and R.C. Data collection and analysis were performed by X.P. and P.F. Article preparation and editing were performed by R.B., D.T., and R.C.
Disclosure Statement
None of the authors have financial relationships with industry or conflicts of interest to disclose.
Funding Information
No funding was received for this study.
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