Congestive heart failure is a risk factor for venous thromboembolism in bariatric surgery

Abstract

Background: Venous thromboembolism (VTE) is a major complication of bariatric surgery leading to significant morbidity and mortality. We sought to identify predictive factors that increase the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) using data from the National Surgical Quality Improvement Program (NSQIP).

Methods: Patients undergoing bariatric procedures from 2005-2012 were identified in the NSQIP database. Pretreatment patient characteristics were examined by laparoscopic and open treatment groups using t tests and chi-square regression. Independent associations between patient characteristics and DVT and PE were examined using logistic regression. Logistic regression was also used to examine whether patients who had postprocedure DVT or PE were more likely than those who did not have these events to have additional morbidity and mortality outcomes.

Results: 102,869 patients underwent bariatric surgery (96,085 laparoscopic; 6,784 open) from 2005-2012. Preoperative variables associated with increased risk of DVT in laparoscopic bariatric surgery are male gender, higher BMI, congestive heart failure (CHF), and hypertension (HTN). Preoperative variables associated with increased risk of PE in laparoscopic bariatric surgery are male gender, age greater than or equal to 60, higher BMI, African American race, chronic obstructive pulmonary disease (COPD) and CHF. There are no preoperative variables associated with an increased risk of DVT in open bariatric surgery although there is a trend toward significance with CHF. Finally, higher BMI and CHF is associated with an increased risk of PE in open bariatric surgery.

Conclusions: CHF is a significant risk factor for VTE in bariatric surgery. Surgeons should consider aggressive screening and VTE prophylaxis in patients with CHF and other known risk factors to decrease postoperative morbidity from VTE.

Keywords: Bariatric surgery; Deep venous thrombosis; Morbidity; Mortality; NSQIP; Pulmonary embolism.