Cirugía general y bariátrica en pacientes obesos con antecedentes de tromboembolia venosa y tratamiento anticoagulante concomitante

Abstract

Objective:The objective of this study was to examine the use and outcomes of perioperative anticoagulation (AC) in obese patients with a known history of venous thromboembolism event (VTE).Method: A retrospective review of a prospective database for patients with a VTE history undergoing bariatric and general surgery at a single center (1/2008-12/2017) was performed.Factors assessed included demographics, surgical details, and outcomes.Results: Sixty-five patients underwent 76 procedures: 46 females (71%); mean age 51 years (range 26-73), mean weight 284 pounds (range 110-558), mean body mass index 45 (range 19-87).Comorbidities include hypertension (60%), gastroesophageal reflux disease (54%), osteoarthritis (49%), obstructive sleep apnea (45%), and diabetes (37%).Operations: 22 general surgeries (29%), 20 sleeve gastrectomies (26%), 12 revisions/conversions (16%), 12 Roux-en-Y gastric bypasses (16%), and 10 gastric bands (13%).Modalities: 67% laparoscopic, 28% robotic, and 5% open.Twenty-two patients (34%) had a pre-operative inferior vena cava filter placed with no complications.The mean length of stay was 4.4 days (range 1-31).Complications: seven 30-day readmissions (9%), one 30-day reoperation (1%), and two 90-day VTEs (3%).Thirty-day readmissions: four for inability to tolerate PO, two for small bowel obstruction, and one for symptomatic anastomotic ulcer.Conclusions: In our patients, post-operative AC could be started without an increased risk of bleeding in patients with a history of VTE undergoing bariatric surgery.