Heart failure is a major risk factor for postoperative venous thromboembolism in bariatric surgery patients

Identifying preoperative comorbidities predictive of postoperative thromboembolic events (e.g. deep vein thrombosis, DVT; pulmonary embolism, PE), may help target higher-risk patients for preventive measures. In 2023, the Metabolic and Bariatric Surgery Quality Improvement Project (MBSAQIP) began capturing preoperative heart failure, a known risk factor for DVT/PE.

This study aimed to analyze the 2023 database to identify and rank preoperative factors including heart failure that are most strongly associated with postoperative DVT/PE risk in patients undergoing metabolic and bariatric surgery (MBS).

Metabolic and Bariatric Surgery Quality Improvement Project (MBSAQIP).

The 2023 MBSAQIP was queried (n = 217,952) and multivariable logistic regression modeling was used to assess factors predictive of postoperative DVT and PE, adjusting for demographics, preoperative comorbidities, and surgical factors.

After a history of prior DVT/PE, a history of heart failure was associated with the second highest odds ratio (OR) for postoperative thromboembolic events (OR: 1.73 [95% CI: 1.12-2.57, P < .01). Other significant risk factors venous thromboembolism (VTE) included older age, higher BMI, male sex, liver disease, and gastroesophageal reflux disease (GERD). Non-revisional (i.e. primary) surgery and therapeutic anticoagulation were identified as factors associated with risk reduction.

This large retrospective analysis demonstrated that patients with a history of heart failure are nearly 2 times as likely to develop VTE after bariatric surgery compared to those with no history of heart failure. Patients with a history of heart failure should be considered high risk for VTE and should be considered for similar VTE prophylaxis as patients with prior DVT/PE.