Celik F, Bounif F, Fliers J M, Kersten B E, van Dielen F M H, Cense H A, Brandjes D P M, van Wagensveld B A, Janssen I M C, van de Laar A W J M, Gerdes V E A
Department of Internal Medicine, Slotervaart Hospital, Room 9B-v010 Louwesweg 6, 1066 EC, Amsterdam, The Netherlands,
Obes Surg. 2014 Oct;24(10):1603-9. doi: 10.1007/s11695-014-1227-9.
Studies suggest that postoperative complications are a risk factor for venous thromboembolism (VTE) after bariatric surgery. Knowledge of factors associated with a higher risk of VTE after bariatric surgery may be essential to select patients who may benefit from either prolonged or intensified thrombosis prophylaxis. The aim of this study is to determine the relationship between postoperative complications and VTE after bariatric surgery and other classical risk factors.
A retrospective multicenter case-control study was performed in patients who had bariatric surgery between January 2008 and September 2011. VTE until 6 months after surgery was registered, and patients were contacted to ascertain the results. For every case of VTE after surgery, 6 control patients were selected who were matched for gender, age, participating center and type of surgery. Risk factors for VTE before and after surgery and postoperative complications were registered.
A total of 2,064 surgeries were included. In 12 patients, VTE occurred within 6 months after bariatric surgery (incidence 0.58 %, 95 % confidence interval (CI) = 0.25-0.93). There was a strong association of complications after surgery (cases 91.7 %, controls 15.3 %, odds ratio (OR) 61.0; 95 % CI = 7.1-521.3) or intensive care admission (cases 50.0 %, controls 11.1 %, OR = 8.0; 95 % CI = 2.1-30.8) with VTE. The majority of postoperative complications were anastomotic leak, abdominal abscess, and infection. We could not detect an association between classical thrombosis risk factors and postoperative VTE.
The incidence of VTE is low after bariatric surgery using thrombosis prophylaxis. However, there is a strong association between postoperative complications and VTE. These patients may benefit from more intensive thrombosis prophylaxis.
研究表明，术后并发症是减肥手术后静脉血栓栓塞症（VTE）的一个危险因素。了解减肥手术后VTE高风险相关因素对于选择可能从延长或强化血栓预防中获益的患者可能至关重要。本研究的目的是确定减肥手术后术后并发症与VTE之间的关系以及其他经典危险因素。
对2008年1月至2011年9月期间接受减肥手术的患者进行了一项回顾性多中心病例对照研究。记录术后6个月内的VTE情况，并联系患者以确定结果。对于每一例术后VTE病例，选择6名在性别、年龄、参与中心和手术类型方面匹配的对照患者。记录手术前后VTE的危险因素和术后并发症。
共纳入2064例手术。12例患者在减肥手术后6个月内发生VTE（发生率0.58%，95%置信区间（CI）=0.25 - 0.93）。术后并发症（病例组91.7%，对照组15.3%，比值比（OR）61.0；95% CI = 7.1 - 521.3）或重症监护病房入住（病例组50.0%，对照组11.1%，OR = 8.0；95% CI = 2.1 - 30.8）与VTE有很强的关联。大多数术后并发症为吻合口漏、腹腔脓肿和感染。我们未发现经典血栓形成危险因素与术后VTE之间存在关联。
采用血栓预防措施后，减肥手术后VTE的发生率较低。然而，术后并发症与VTE之间存在很强的关联。这些患者可能从更强化的血栓预防中获益。
