Pulmonary Embolism and Deep Venous Thrombosis Following Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Pulmonary Embolism and Deep Venous Thrombosis Following Bariatric Surgery Paul D. Stein & Fadi Matta
Published online: 13 February 2013 # Springer Science+Business Media New York 2013
Abstract Background The contribution of obesity to the thromboembolic risks of surgery suggests that patients undergoing bariatric surgery would have a particularly high risk of postoperative pulmonary embolism (PE) and/or deep venous thrombosis (DVT). This study aimed to assess the prevalence of in-hospital PE, DVT, and venous thromboembolism (VTE) following bariatric surgery in the USA from 2007 to 2009. Methods We used the database of the Nationwide Inpatient Sample. Results The prevalence of PE was 4,500 of 508,230 (0.9 %). The prevalence of DVT not accompanied by PE was 6,480 of 508,230 (1.3 %) and VTE (either PE or DVT) occurred in 10,980 of 508,230 (2.2 %). In-hospital death among patients with PE was 130 of 508,231 (0.03 %). Vena cava filters were inserted in 1,515 of 508,230 (0.3 %) patients who underwent bariatric surgery. Among patients who had VTE, filters were inserted in 1,150 of 10,980 (10.5 %). Among patients who had
P. D. Stein : F. Matta Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA P. D. Stein e-mail: [email protected] F. Matta Department of Research, St. Mary Mercy Hospital, Livonia, MI, USA F. Matta (*) Department of Research, St. Mary Mercy Hospital, 36475 Five Mile Road, Livonia, MI 48154, USA e-mail: [email protected]
neither PE nor DVT, prophylactic vena cava filters were inserted in 365 of 497,250 (0.07 %). Among patients with PE, in-hospital mortality was 25 of 635 (3.9 %) with a filter compared with 105 of 3,865 (2.7 %) (NS) without a filter. However, among patients with DVT alone, in-hospital mortality was 0 of 510 (0 %) with a filter compared with 80 of 5,970 (1.3 %) (P=0.009) without a filter. Conclusions This investigation establishes a baseline for the incidence of venous thromboembolic complications following bariatric surgery in recent years. Determination of the present in-hospital rate of PE and DVT may contribute to antithrombotic prophylactic considerations. Keywords Pulmonary embolism . Deep venous thrombosis . Venous thromboembolism . Bariatric surgery Obesity is a risk factor for deep venous thrombosis (DVT) and pulmonary embolism (PE) [1, 2], and the contribution of obesity to the thromboembolic risks of surgery would suggest that patients undergoing bariatric surgery would have a particularly high risk of postoperative PE and/or DVT. The American College of Chest Physicians in 2012 recommended that antithrombotic prophylaxis for most patients undergoing bariatric surgery should be as recommended for high-risk non-orthopedic surgical patients, which is pharmacologic prophylaxis with low-molecularweight heparin or low-dose unfractionated heparin in combination with elastic stockings or intermittent pneumatic compression (IPC) [3]. Some, however, may be of moderate risk, i
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