Use of post-discharge heparin prophylaxis and the risk of venous thromboembolism and bleeding following bariatric surger
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and Other Interventional Techniques
Use of post‑discharge heparin prophylaxis and the risk of venous thromboembolism and bleeding following bariatric surgery Erin B. Fennern1,2 · Farhood Farjah1 · Judy Y. Chen1 · Francys C. Verdial1 · Sara B. Cook1 · Erika M. Wolff1 · Saurabh Khandelwal1 Received: 10 June 2020 / Accepted: 26 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Venous thromboembolism (VTE) is a significant cause of morbidity and mortality after bariatric surgery. Roughly 80% of VTEs occur post-discharge. The frequency of post-discharge heparin (PDH) prophylaxis use is unknown, and evidence about benefits and risks is limited. We aimed to determine the rate of use of PDH prophylaxis and evaluate its relationship with VTE and bleeding events. Methods Using the Truven Health MarketScan® database, we performed a retrospective cohort study (2007–2015) of adult patients who underwent sleeve gastrectomy or gastric bypass. We determined PDH prophylaxis from outpatient pharmacy claims, and post-discharge 90-day VTE and bleeding events from outpatient and inpatient claims. We used propensity scoreadjusted regression models to mitigate confounding bias. Results Among 43,493 patients (median age 45 years; 78% women; 77% laparoscopic gastric bypass, 17% laparoscopic sleeve gastrectomy, 6% open gastric bypass), 6% received PDH prophylaxis. Overall, 224 patients (0.52%) experienced VTEs, and 806 patients (1.85%) experienced bleeding. The unadjusted VTE rate did not differ between patients who did and did not receive PDH prophylaxis (0.39% vs. 0.52%, respectively; p = 0.347). The unadjusted bleeding rate was higher for the PDH prophylaxis group (2.74% vs. 1.80%, p 35 days of PHD prophylaxis (n=55) Final Cohort (n=43,493)
Fig. 1 Flow diagram of study population
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Surgical Endoscopy
endoscopy with control of bleeding occurring up to 90 days after index discharge. We selected the following a priori covariates to include in bivariate and multivariate analyses: age, sex, index admission length of stay, insurance plan type (high-deductible, low-deductible, or managed care/capitated), operation type (laparoscopic sleeve, laparoscopic or open gastric bypass), geographic region, and calendar year. Comorbidities were identified from ICD-9 diagnostic codes attached to outpatient and inpatient claims in the 90 days before surgery. The Quan modification [25] of the Charlson Comorbidity Index (CCI) was determined and included as a covariate. (See Online Appendix 1 for a complete list of ICD-9 and CPT codes used in this study).
Statistical analysis Medians were used to summarize the non-normally distributed continuous variables. Frequencies were used to summarize categorical variables (sex, insurance plan type, operation type, region, CCI, year). Baseline data were stratified by receipt of PDH prophylaxis, and tests of differences between prophylaxis groups were performed. Bivariate tests of association between categorical variables and outcomes were compared us
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