Postoperative VTE Risk Predictors Identified in Bariatric Surgery Patients

A history of venous thromboembolism (VTE) and reoperation are associated with the risk of mortality in the 30 days following bariatric surgery, according to a recent study.

Findings were presented at the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 22nd World Congress, which is taking place August 29 to September 2, 2017, in London.
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VTE is among the most common causes of death following bariatric surgery. However, little is known about the factors associated with a higher risk of VTE. Identification of these factors is crucial for early risk prevention.

To further explore the potential factors associated with VTE in the 30 days after surgery, the researchers assessed 143,483 patients who had received primary laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass in 2015. Follow-up lasted 30 days.

The researchers used stepwise selection regression to construct a model to predict the risk for 30-day postoperative VTE. The model was developed using a training set of patients (n = 71,577) and was validated using a testing dataset of patients (n = 71,906). Additionally, a user-friendly online risk calculator was created via identification of significant risk factors, and the cutoff point was determined via the maximum Youden index.

Results indicated that the overall 30-day incidence of postoperative VTE was 0.31%. The researchers observed a higher risk of VTE among men and patients with a history of VTE or gastroesophageal reflux disease and those who had received a reoperation. They also found that the model provided good calibration and fair discrimination. Validation of the model yielded similar results.

“History of previous VTE and reoperation are associated with the highest risk of 30-day postoperative VTE,” the researchers concluded. “Extended pharmacoprophylaxis should be considered for high-risk patients [with a VTE risk higher than 0.4%].”

—Christina Vogt

Reference:

Janik M, Rogula T, Mustafa R, Alhaj Saleh A, Khaitan L. Risk assessment tool for venous thromboembolism after bariatric surgery: results from the metabolic and bariatric surgery accreditation and quality improvement program. Paper presented at: IFSO 22nd World Congress; August 29-September 2, 2017; London, UK. https://link.springer.com/content/pdf/10.1007%2Fs11695-017-2774-7.pdf. Accessed August 30, 2017.