Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery · 2025
Impact of chronic anticoagulation on perioperative outcomes in patients undergoing minimally invasive bariatric surgery-Propensity score-matched analysis using the 2020-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.
СтатьяНазвание и аннотация: Перевод в очереди
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Boaz Elad, Aeschbacher Pauline, Kahana Noam, Horesh Nir, Lo Menzo Emanuele, Szomstein Samuel, Rosenthal Raul J
Аннотация
BACKGROUND: The management of individuals receiving chronic anticoagulation (CAC) who are undergoing bariatric surgery presents a complex challenge, because there is a delicate balance between risks of perioperative bleeding and thromboembolic events.
OBJECTIVES: To evaluate and compare rates of bleeding, thrombotic events, and overall outcomes of patients on CAC undergoing bariatric surgery.
SETTING: United States.
METHODS: Data spanning 2020 to 2021 were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, with a focus on patients who underwent primary minimally invasive bariatric surgery. A multivariable regression analysis examined 30-day outcomes for patients anticoagulated preoperatively. In addition, a propensity-matched analysis was performed comparing outcomes among patients on CAC and those without.
RESULTS: In total 331,201 patients were analyzed, with 8428 (2.5%) receiving CAC. Propensity score matching revealed that patients on CAC exhibited greater rates of reoperations within 30 days (1.9% versus 1.3%, P < .001), overall readmissions after 30 days (7.2% versus 3.3% respectively, P < .0001), and reinterventions within 30 days (1.6% versus .9%, P < .0001) compared with patients not on preoperative CAC. Transfusion intra/postoperative and postoperative gastrointestinal tract bleeding events were elevated in the preoperative therapeutic anticoagulant group (2.2% versus .8%, P < .0001 and 1.4% versus .3%, P < .0001, respectively) compared with no preoperative CAC group.
CONCLUSIONS: Patients undergoing bariatric surgery while on preoperative CAC face significantly increased risks of adverse postoperative outcomes. Individuals requiring long-term anticoagulation should undergo careful consideration before proceeding with bariatric surgery.
OBJECTIVES: To evaluate and compare rates of bleeding, thrombotic events, and overall outcomes of patients on CAC undergoing bariatric surgery.
SETTING: United States.
METHODS: Data spanning 2020 to 2021 were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, with a focus on patients who underwent primary minimally invasive bariatric surgery. A multivariable regression analysis examined 30-day outcomes for patients anticoagulated preoperatively. In addition, a propensity-matched analysis was performed comparing outcomes among patients on CAC and those without.
RESULTS: In total 331,201 patients were analyzed, with 8428 (2.5%) receiving CAC. Propensity score matching revealed that patients on CAC exhibited greater rates of reoperations within 30 days (1.9% versus 1.3%, P < .001), overall readmissions after 30 days (7.2% versus 3.3% respectively, P < .0001), and reinterventions within 30 days (1.6% versus .9%, P < .0001) compared with patients not on preoperative CAC. Transfusion intra/postoperative and postoperative gastrointestinal tract bleeding events were elevated in the preoperative therapeutic anticoagulant group (2.2% versus .8%, P < .0001 and 1.4% versus .3%, P < .0001, respectively) compared with no preoperative CAC group.
CONCLUSIONS: Patients undergoing bariatric surgery while on preoperative CAC face significantly increased risks of adverse postoperative outcomes. Individuals requiring long-term anticoagulation should undergo careful consideration before proceeding with bariatric surgery.