Raelina S. Howell, Department of Surgery, NYU Langone Hospital–Long Island; Department of Surgery, NYU–Long Island School of Medicine, Mineola; New York, USA
Helen H. Liu, Department of Surgery, NYU Langone Hospital–Long Island; Department of Surgery, NYU–Long Island School of Medicine, Mineola; New York, USA
Collin E. M. Brathwaite, Department of Surgery, NYU Langone Hospital–Long Island; Department of Surgery, NYU–Long Island School of Medicine, Mineola; New York, USA
Patrizio Petrone, Department of Surgery, New York University Grossman Long Island School of Medicine, NYU Langone Hospital—Long Island, Mineola, New York, USA
Meredith Akerman, Division of Health Services Research, NYU Long Island School of Medicine, Mineola. New York, USA
Collin E. M. Brathwaite, Department of Surgery, NYU Langone Hospital–Long Island; Department of Surgery, NYU–Long Island School of Medicine, Mineola; New York, USA
Objective: The objective of this study was to examine the use and outcomes of perioperative anticoagulation (AC) in obese patients with a known history of venous thromboembolism event (VTE). Method: A retrospective review of a prospective database for patients with a VTE history undergoing bariatric and general surgery at a single center (1/2008-12/2017) was performed. Factors assessed included demographics, surgical details, and outcomes. Results: Sixty-five patients underwent 76 procedures: 46 females (71%); mean age 51 years (range 26-73), mean weight 284 pounds (range 110-558), mean body mass index 45 (range 19-87). Comorbidities include hypertension (60%), gastroesophageal reflux disease (54%), osteoarthritis (49%), obstructive sleep apnea (45%), and diabetes (37%). Operations: 22 general surgeries (29%), 20 sleeve gastrectomies (26%), 12 revisions/conversions (16%), 12 Roux-en-Y gastric bypasses (16%), and 10 gastric bands (13%). Modalities: 67% laparoscopic, 28% robotic, and 5% open. Twenty-two patients (34%) had a pre-operative inferior vena cava filter placed with no complications. The mean length of stay was 4.4 days (range 1-31). Complications: seven 30-day readmissions (9%), one 30-day reoperation (1%), and two 90-day VTEs (3%). Thirty-day readmissions: four for inability to tolerate PO, two for small bowel obstruction, and one for symptomatic anastomotic ulcer. Conclusions: In our patients, post-operative AC could be started without an increased risk of bleeding in patients with a history of VTE undergoing bariatric surgery.
Keywords: Anticoagulation. Bariatric surgery. Deep vein thrombosis. Morbid obesity. Pulmonary embolism.