Faculty Collaboration Database

Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery. Surg Obes Relat Dis 2022 Dec;18(12):1385-1391

Date

10/06/2022

Pubmed ID

36198496

DOI

10.1016/j.soard.2022.07.016

Scopus ID

2-s2.0-85143379818 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

BACKGROUND: Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death.

OBJECTIVE: Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence.

SETTING: Prospective, statewide bariatric-specific clinical registry.

METHODS: We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT.

RESULTS: A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64-5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36-4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98-30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65-33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76-22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57-16.06; P < .0001).

CONCLUSIONS: Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.

Author List

Carlin AM, Varban OA, Ehlers AP, Bonham AJ, Ghaferi AA, Finks JF

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aftercare
Bariatric Surgery
Gastrectomy
Humans
Laparoscopy
Mesenteric Veins
Obesity, Morbid
Patient Discharge
Portal Vein
Postoperative Complications
Prospective Studies
Venous Thromboembolism
Venous Thrombosis