Preoperative anticoagulation in patients undergoing bariatric surgery is associated with worse outcomes

Management of patients on chronic anticoagulation (AC) in bariatric surgery may present a challenge, as there is a delicate balance between risks of bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The purpose of this study was to evaluate and compare rates of bleeding, thrombotic events, and outcomes of patients on preoperative AC during bariatric surgery.

The MBSAQIP data sets for 2015 and 2016 was used to identify all patients undergoing adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB). Clinical outcomes included length of stay, 30-day readmission, 30-day reoperations and interventions, perioperative and 30-day death events, need for transfusion, PE, and DVT. Following univariate analysis, multivariable logistic regression models and generalized linear regression model for a negative binomial distributed count outcomes were used after adjusting for surgery type and other factors related to each outcome.

There were 269,243 records extracted, as there were 6541 (2.43%) patients on preoperative AC. Rates of transfusion, DVT, and PE were 0.67%, 0.18%, and 0.11%. Following multivariable logistic regression, patients with preoperative AC had higher risks of bleeding and DVT (OR 2.7, 95% CI 2.3-3.3, p-value < 0.0001 and OR 2.8, 95% CI 1.9-4, p-value < 0.0001, respectively). In addition, patients with pre-op AC had a higher risk of 30-day readmission (OR 2.1, 95% CI 1.9-2.3, p < 0.0001)/reoperation (OR 1.5, 95% CI 1.2-1.7, p < 0.0001)/reintervention (OR 2.1, 95% CI 1.8-2.4, p < 0.0001), mortality (OR 2.9, 95% CI 2.04-4.069, p < 0.0001), and longer LOS (ratio 1.2, 95% CI 1.199-1.241, p < 0.0001).

Patients with preoperative AC had worse postoperative outcomes. Bariatric surgeons should be aware of the increased morbidity and mortality, and care must be taken to improve outcomes through close attention to postoperative AC protocols in this group of patients.