Evaluating Trends in Bleeding Complications Associated with Metabolic Bariatric Surgery: A 14-Year Single-Center...

Background/Objectives: Gastrointestinal bleeding after metabolic bariatric surgery is a relatively rare adverse event, but it has significant morbidity potential. The clinical course can be rapidly unfavorable, requiring early recognition and prompt intervention. The management of this complication often involves different approaches, surgical or endoscopic, the use of which is influenced by the particularities of the postoperative anatomy and the timing of the bleeding. This study aimed to evaluate the incidence, clinical characteristics, and factors associated with postoperative bleeding following bariatric surgery. Methods: A retrospective observational study was conducted on patients who underwent bariatric surgery between 2012 and 2025 at a single tertiary center. During this period, 1010 bariatric procedures were performed. Of these, 68 patients developed postoperative complications and 24 experienced postoperative bleeding. Postoperative bleeding was defined as a hemoglobin drop > 2 g/dL and/or clinically evident bleeding requiring intervention. As bleeding represents a specific subtype of postoperative complication, all statistical analyses were restricted to patients with documented complications. Results: Among the 68 patients with postoperative complications, 24 (35.3%) developed postoperative bleeding. In this exploratory analysis, male sex showed a signal suggestive of association with postoperative bleeding (OR: 9.69, p = 0.005); however, this finding should be interpreted as hypothesis-generating given the study design and the analysis's being restricted to patients with complications. Given the limited number of bleeding events, effect estimates should be interpreted cautiously. In an exploratory multivariate model, dyslipidemia was associated with increased odds of bleeding (OR: 19.90, p = 0.047), while hepatomegaly and male sex showed positive but non-significant associations. Conclusions: Among patients who developed postoperative complications after bariatric surgery, male sex emerged as a potential signal associated with postoperative bleeding in this exploratory analysis. These findings should be interpreted as hypothesis-generating rather than definitive predictors and require validation in larger cohorts. Dyslipidemia and hepatomegaly emerged as potential associated factors in exploratory analyses, but these findings require confirmation in prospective and multicentric studies.