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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

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Extended postoperative venous thromboembolism prophylaxis after bariatric surgery: a comparison of existing

Joseph R Imbus¹, Andrew D Jung¹, S Davis¹

¹Department of General and Gastrointestinal Surgery, Emory University, Atlanta, Georgia.

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery

|June 23, 2023

Abstract

Background:

Venous thromboembolism (VTE) is a leading cause of 30-day mortality after metabolic and bariatric surgery (MBS). Multiple predictive tools exist for VTE risk assessment and extended VTE chemoprophylaxis determination.

Objective:

To review existing risk-stratification tools and compare their predictive abilities.

Setting:

MBSAQIP database.

Methods:

Retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was performed (2015-2019) for primary minimally invasive MBS cases. VTE clinical factors and risk-assessment tools were evaluated: body mass index threshold of 50 kg/m², Caprini risk-assessment model, and 3 bariatric-specific tools: the Cleveland Clinic VTE risk tool, the Michigan Bariatric Surgery Collaborative tool, and BariClot. MBS patients were deemed high risk based on criteria from each tool and further assessed for sensitivity, specificity, and positive predictive value.

Results:

Overall, 709,304 patients were identified with a .37% VTE rate. Bariatric-specific tools included multiple predictors: procedure, age, race, gender, operative time, length of stay, heart failure, and dyspnea at rest; operative time was the only variable common to all. The body mass index cutoff and Caprini risk-assessment model had higher sensitivity but lower specificity when compared with the Michigan Bariatric Surgery Collaborative and BariClot tools. While the sensitivity of the tools varied widely and was overall low, the Cleveland Clinic tool had the highest sensitivity. The bariatric-specific tools would have recommended extended prophylaxis for 1.1%-15.6% of patients.

Conclusions:

Existing MBS VTE risk-assessment tools differ widely for inclusion variables, high-risk definition, and predictive performance. Further research and registry inclusion of all significant risk factors are needed to determine the optimal risk-stratified approach for predicting VTE events and determining the need for extended prophylaxis.

Keywords:

Bariatric surgery Deep vein thrombosis Extended prophylaxis Gastric bypass Heparin Lovenox Pulmonary embolism Risk-assessment tools Sleeve gastrectomy Venous thromboembolism

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