Predictors of postoperative bleeding after minimally invasive bariatric surgery

Raul Sebastian; Alba Zevallos; Jorge Cornejo; Joaquin Sarmiento; Christina Li; Michael Schweitzer; Gina L Adrales

doi:10.1007/s00464-024-11284-x

Predictors of postoperative bleeding after minimally invasive bariatric surgery

Surg Endosc. 2024 Oct 4. doi: 10.1007/s00464-024-11284-x. Online ahead of print.

Authors

Raul Sebastian^{1

2

3}, Alba Zevallos^{4

5}, Jorge Cornejo⁴, Joaquin Sarmiento⁴, Christina Li⁴, Michael Schweitzer⁶, Gina L Adrales⁶

Affiliations

¹ Department of Surgery, Northwest Hospital, Randallstown, MD, USA. rsebast04@gmail.com.
² Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA. rsebast04@gmail.com.
³ Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD, 21093, USA. rsebast04@gmail.com.
⁴ Department of Surgery, Northwest Hospital, Randallstown, MD, USA.
⁵ Universidad Cientifica del Sur, Lima, Peru.
⁶ Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.

PMID: 39367135
DOI: 10.1007/s00464-024-11284-x

Abstract

Background: Minimally invasive bariatric surgeries provide effective weight loss with fewer complications. However, postoperative bleeding remains a significant concern due to its potential for serious morbidity and mortality. This study aimed to identify factors predicting postoperative bleeding following laparoscopic and robotic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Methods: We analyzed patients who underwent SG and RYGB using the MBSAQIP database from 2015 to 2021. Four multivariate logistic regression analyses were conducted to investigate the relationship between postoperative bleeding and 24 independent factors for laparoscopic SG (lapSG), robotic SG (rSG), laparoscopic RYGB (lapRYGB), and robotic RYGB (rRYGB).

Results: We analyzed 659,294 lapSG, 53,548 rSG, 267,171 lapRYGB, and 22,492 rRYGB patients. In lapSG, the most significant factors included anticoagulation (OR 3.76; 95% CI 3.13-4.51), renal insufficiency (OR 2.06; 95% CI 1.37-3.09), history of DVT (OR 1.87; 95% CI 1.23-2.85), history of PE (OR 1.69; 95% CI 1.04-2.76, and BMI ≤ 40 (OR 1.22; 95% CI 1.09-1.38). In the rSG group, anticoagulation (OR 4.95; 95% CI 2.83-8.66), COPD (OR 2.80; 95% CI 1.29-6.05), and hyperlipidemia (OR 1.90; 95% CI 1.29-6.05) were significant factors. In lapRYGB, the most significant factors included anticoagulation (OR 3.68; 95% CI 3.11-4.35), renal insufficiency (OR 1.60; 95% CI 1.04-2.44), history of DVT (OR 1.70; 95% CI 1.09-2.07), cardiac stent (OR 1.51; 95% CI 1.09-2.07), and BMI ≤ 40 (OR 1.16; 95% CI 1.03-1.29). For rRYGB, anticoagulation (OR 4.69; 95% CI 2.86-7.70), history of PE (OR 4.28; 95% CI 1.53-12.00), and cardiac stent (OR 2.15; 95% CI 0.06-4.34) were significant.

Conclusion: Preoperative anticoagulation, renal insufficiency, history of DVT and PE, a cardiac stent, and BMI ≤ 40 are associated with an increased risk of postoperative bleeding. The predictive factors were consistent across laparoscopic and robotic approaches in SG and RYGB procedures.

Keywords: Bleeding; Gastric bypass; Minimally invasive surgery; Sleeve gastrectomy.