Department of Surgery, NYU Langone Hospital-Long Island.
Department of Surgery, NYU-Long Island School of Medicine, Mineola.
Cir Cir. 2024;92(4):475-480. doi: 10.24875/CIRU.23000190.
The objective of this study was to examine the use and outcomes of perioperative anticoagulation (AC) in obese patients with a known history of venous thromboembolism event (VTE).
A retrospective review of a prospective database for patients with a VTE history undergoing bariatric and general surgery at a single center (1/2008-12/2017) was performed. Factors assessed included demographics, surgical details, and outcomes.
Sixty-five patients underwent 76 procedures: 46 females (71%); mean age 51 years (range 26-73), mean weight 284 pounds (range 110-558), mean body mass index 45 (range 19-87). Comorbidities include hypertension (60%), gastroesophageal reflux disease (54%), osteoarthritis (49%), obstructive sleep apnea (45%), and diabetes (37%). Operations: 22 general surgeries (29%), 20 sleeve gastrectomies (26%), 12 revisions/conversions (16%), 12 Roux-en-Y gastric bypasses (16%), and 10 gastric bands (13%). Modalities: 67% laparoscopic, 28% robotic, and 5% open. Twenty-two patients (34%) had a pre-operative inferior vena cava filter placed with no complications. The mean length of stay was 4.4 days (range 1-31). Complications: seven 30-day readmissions (9%), one 30-day reoperation (1%), and two 90-day VTEs (3%). Thirty-day readmissions: four for inability to tolerate PO, two for small bowel obstruction, and one for symptomatic anastomotic ulcer.
In our patients, post-operative AC could be started without an increased risk of bleeding in patients with a history of VTE undergoing bariatric surgery.
本研究旨在探讨肥胖并伴有静脉血栓栓塞事件（VTE）病史的患者围手术期抗凝（AC）的使用情况及其结局。
对一家单中心（2008 年 1 月至 2017 年 12 月）的 VTE 病史患者接受减重和普外科手术的前瞻性数据库进行回顾性分析。评估的因素包括人口统计学、手术细节和结局。
65 例患者共行 76 例手术：女性 46 例（71%）；平均年龄 51 岁（范围 26-73 岁），平均体重 284 磅（范围 110-558 磅），平均体重指数 45（范围 19-87）。合并症包括高血压（60%）、胃食管反流病（54%）、骨关节炎（49%）、阻塞性睡眠呼吸暂停（45%）和糖尿病（37%）。手术类型：普外科手术 22 例（29%）、袖状胃切除术 20 例（26%）、修正术/转化术 12 例（16%）、Roux-en-Y 胃旁路术 12 例（16%）、胃束带术 10 例（13%）。手术方式：腹腔镜 67%、机器人 28%、开放 5%。22 例患者（34%）术前放置了下腔静脉滤器，无并发症发生。平均住院时间为 4.4 天（范围 1-31 天）。并发症：30 天内再入院 7 例（9%）、30 天内再手术 1 例（1%）、90 天内静脉血栓栓塞症 2 例（3%）。30 天内再入院：4 例因无法耐受口服药物、2 例因小肠梗阻、1 例因吻合口溃疡症状性出血。
在我们的患者中，VTE 病史患者在接受减重手术后可以开始使用 AC，而不会增加出血风险。
