Bariatric surgery in patients with preoperative therapeutic anticoagulation: a 2015-2021 MBSAQIP database study

Sebastian Leon; Armaun D Rouhi; Juan E Perez; Angelika N Alberstadt; Colleen M Tewksbury; Victoria M Gershuni; Maria S Altieri; Noel N Williams; Kristoffel R Dumon

doi:10.1016/j.soard.2024.07.018

Bariatric surgery in patients with preoperative therapeutic anticoagulation: a 2015-2021 MBSAQIP database study

Surg Obes Relat Dis. 2024 Aug 8:S1550-7289(24)00719-6. doi: 10.1016/j.soard.2024.07.018. Online ahead of print.

Authors

Sebastian Leon¹, Armaun D Rouhi¹, Juan E Perez¹, Angelika N Alberstadt¹, Colleen M Tewksbury¹, Victoria M Gershuni¹, Maria S Altieri¹, Noel N Williams¹, Kristoffel R Dumon²

Affiliations

¹ Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Kristoffel.Dumon@pennmedicine.upenn.edu.

PMID: 39232872
DOI: 10.1016/j.soard.2024.07.018

Abstract

Background: The link between obesity and adverse cardiovascular events is well-established. With the rising prevalence of metabolic and bariatric surgery (MBS), a greater number of patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) may present with preoperative therapeutic anticoagulation (AC).

Objectives: This study evaluated perioperative outcomes of SG and RYGB in patients on preoperative AC.

Setting: Patients reported to the 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

Methods: Adults undergoing primary SG or RYGB with and without preoperative anticoagulation (SG-AC or RYGB-AC and non-SG-AC or non-RYGB-AC, respectively) were analyzed from the 2015-2021 MBSAQIP database. Differences in baseline characteristics by AC status for each MBS were adjusted using entropy-balanced weights. Multivariable logistic and linear regressions were developed to analyze the independent association between AC and outcomes of interest.

Results: Of 1,178,090 patients included, 72.0% (n = 850,682) had SG and 28.0% (n = 327,408) had RYGB, of which 1.8% (n = 15,021) and 1.9% (n = 6201) had AC, respectively. Compared to non-SG-AC and non-RYGB-AC, both SG-AC and RYGB-AC encountered higher absolute 30-day rates of anastomotic leak, deep vein thrombosis and gastrointestinal bleeding. Following multivariable adjustment, SG-AC was associated with significantly greater odds of adverse cardiovascular events, anastomotic leak, gastrointestinal bleeding, and greater operative length and length of stay. RYGB-AC was associated with higher odds of readmission, unplanned ICU admission, and ED visit.

Conclusions: While preoperative AC may confer distinct outcomes between SG and RYGB, this 7-year study of MBSAQIP demonstrated an overall association with greater postoperative morbidity. Management of MBS patients with preoperative AC requires consideration of thrombohemorrhagic risks.

Keywords: Anticoagulation; Bariatric surgery; Bleeding; MBSAQIP; Outcomes; Thromboembolism.