Sharma Gautam, Hanipah Zubaidah Nor, Aminian Ali, Punchai Suriya, Bucak Emre, Schauer Philip R, Brethauer Stacy A
Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia.
Obes Surg. 2018 Aug;28(8):2225-2232. doi: 10.1007/s11695-018-3120-4.
Perioperative management of chronically anti-coagulated patients undergoing bariatric surgery requires a balance of managing hemorrhagic and thromboembolic risks. The aim of this study is to evaluate the incidence of hemorrhagic complications and their management in chronically anticoagulated (CAT) patients undergoing bariatric surgery.
A retrospective review of CAT patients undergoing bariatric surgery at an academic center from 2008 to 2015 was studied.
A total of 153 patients on CAT underwent surgery [Roux-en-Y gastric bypass (n = 79), sleeve gastrectomy (n = 63), and adjustable gastric banding (n = 11)] during the study period: 85 patients (55%) were females; median age was 56 years (interquartile range [IQR] 49-64), and median BMI was 49 kg/m (IQR 43-56). The most common indications for CAT were venous thromboembolism (n = 87) and atrial fibrillation (n = 83). Median duration of procedure and estimated intraoperative blood loss was 150 min (IQR 118-177) and 50 ml (IQR 25-75), respectively. Thirty-day postoperative complications were reported in 33 patients (21.6%) including postoperative bleeding (n = 19), anastomotic leak (n = 3), and pulmonary embolism (n = 1). Nineteen patients (12%) with early postoperative bleeding were further categorized to intra-abdominal (n = 10), intraluminal (n = 6), and at the port site or abdominal wall (n = 3). All-cause readmissions within 30 days of surgery occurred in 19 patients (12%). There was no 30-day mortality.
In our experience, patients who require chronic anticoagulation medication are higher than average risk for postoperative complications and all-cause readmission rates. Careful surgical technique and close attention to postoperative anticoagulation protocols are essential to decrease perioperative risk in this high-risk cohort.
接受减肥手术的长期抗凝患者的围手术期管理需要平衡出血风险和血栓栓塞风险的管理。本研究的目的是评估接受减肥手术的长期抗凝（CAT）患者出血并发症的发生率及其管理。
对2008年至2015年在一个学术中心接受减肥手术的CAT患者进行回顾性研究。
在研究期间，共有153例CAT患者接受了手术[ Roux-en-Y胃旁路术（n = 79）、袖状胃切除术（n = 63）和可调节胃束带术（n = 11）]：85例患者（55%）为女性；中位年龄为56岁（四分位间距[IQR] 49 - 64），中位BMI为49kg/m²（IQR 43 - 56）。CAT最常见的指征是静脉血栓栓塞（n = 87）和心房颤动（n = 83）。手术中位持续时间和估计术中失血量分别为150分钟（IQR 118 - 177）和50毫升（IQR 25 - 75）。33例患者（21.6%）报告了术后30天并发症，包括术后出血（n = 19）、吻合口漏（n = 3）和肺栓塞（n = 1）。19例（12%）术后早期出血患者进一步分为腹腔内出血（n = 10）、腔内出血（n = 6）以及端口部位或腹壁出血（n = 3）。19例患者（12%）在术后30天内发生了全因再入院。无30天死亡率。
根据我们的经验，需要长期抗凝药物治疗的患者术后并发症和全因再入院率高于平均风险。谨慎的手术技术和密切关注术后抗凝方案对于降低这一高危人群的围手术期风险至关重要。
