Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Department of Surgery, University of Alberta Hospital, University of Alberta, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
Surg Endosc. 2019 Mar;33(3):821-831. doi: 10.1007/s00464-018-6348-0. Epub 2018 Jul 12.
Bariatric surgery is an effective treatment for severe obesity; however, postoperative venous thromboembolism (VTE) remains a leading cause of morbidity and mortality. The objective of this study is to develop a tool to stratify individuals undergoing laparoscopic bariatric surgery according to their 30-day VTE risk.
This is a retrospective cohort study of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. This registry collects data specific for metabolic or bariatric surgery with 30-day outcomes from 791 centers. Individuals undergoing primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were included. Characteristics associated with 30-day VTE were identified using univariate and multivariable analyses. A predictive model, BariClot, was derived from a randomly-generated derivation cohort using a forward selection algorithm. BariClot's robustness was tested against a validation cohort of subjects not included in the derivation cohort. The calibration and discrimination of two previously published VTE risk tools were assessed in the MBSAQIP population and compared to BariClot.
A total of 274,221 patients underwent LRYGB or LSG. Overall, 1106 (0.4%) patients developed VTE, 452 (0.2%) developed pulmonary embolism, and 43 (0.02%) died due to VTE. VTE was the most commonly identified cause of 30-day mortality. A prediction model to assess for risk of VTE, BariClot, was derived and validated. BariClot consists of history of VTE, operative time, race, and functional status. It stratifies individuals into very high (> 2%), high (1-2%), medium (0.3-1%), and low risk groups (< 0.3%). This model accurately predicted events in the validation cohort and outperformed previously published scoring systems.
BariClot is a predictive tool that stratifies individuals undergoing bariatric surgery based on 30-day VTE risk. Stratifying low- and high-risk populations for VTE allows for informed clinical decision-making and potentially enables further research on customized prophylactic measures for low- and high-risk populations.
减重手术是治疗重度肥胖的有效方法；然而，术后静脉血栓栓塞（VTE）仍然是发病率和死亡率的主要原因。本研究旨在开发一种工具，根据腹腔镜减重手术患者的 30 天 VTE 风险对其进行分层。
这是一项对代谢和减重手术认证和质量改进计划（MBSAQIP）数据库的回顾性队列研究。该登记处收集来自 791 个中心的代谢或减重手术特定数据以及 30 天结果。包括接受原发性腹腔镜 Roux-en-Y 胃旁路术（LRYGB）或腹腔镜袖状胃切除术（LSG）的患者。使用单变量和多变量分析确定与 30 天 VTE 相关的特征。使用向前选择算法从随机生成的推导队列中得出预测模型 BariClot。在不包括推导队列中的受试者的验证队列中测试 BariClot 的稳健性。在 MBSAQIP 人群中评估并比较 BariClot 与两个先前发表的 VTE 风险工具的校准和区分。
共有 274221 名患者接受了 LRYGB 或 LSG。总体而言，1106 名（0.4%）患者发生 VTE，452 名（0.2%）发生肺栓塞，43 名（0.02%）因 VTE 死亡。VTE 是 30 天死亡率最常见的原因。开发并验证了一种评估 VTE 风险的预测模型 BariClot。BariClot 由 VTE 病史、手术时间、种族和功能状态组成。它将个体分为极高（>2%）、高（1-2%）、中（0.3-1%）和低风险组（<0.3%）。该模型准确预测了验证队列中的事件，并且优于先前发表的评分系统。
BariClot 是一种预测工具，可根据 30 天 VTE 风险对接受减重手术的个体进行分层。对 VTE 的低风险和高风险人群进行分层可进行明智的临床决策，并有可能为低风险和高风险人群的定制预防措施进一步研究提供信息。
