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.

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.