Rouhi Armaun D, Leon Sebastian, Perez Juan E, Tewksbury Colleen M, Gershuni Victoria M, Altieri Maria S, Williams Noel N, Dumon Kristoffel R
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
Surg Obes Relat Dis. 2025 Jul 30. doi: 10.1016/j.soard.2025.07.009.
Inferior vena cava filters (IVCFs) are utilized to mitigate the incidence of thromboembolic complications after bariatric surgery.
This study compared 30-day outcomes between patients with and without IVCFs present at the time of sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).
Patients reported to the 2018-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
Adults undergoing primary SG or RYGB, with and without IVCFs present (SG-IVCF and SG-only or RYGB-IVCF and RYGB-only, respectively), were identified. Baseline characteristics by IVCF status for each procedure were adjusted using entropy balancing. Multivariable weighted logistic and linear regressions were subsequently developed to evaluate the independent association between the presence of IVCF at the time of bariatric surgery and outcomes of interest.
Of 721,161 patients included, 71.9% (n = 518,454) underwent SG and 28.1% (n = 202,707) underwent RYGB, of which .3% (n = 1471) and .3% (n = 643) had IVCFs present, respectively. Compared to SG-only and RYGB-only, SG-IVCF and RYGB-IVCF had higher unadjusted 30-day rates of deep vein thrombosis, while only RYGB-IVCF had higher rates of pulmonary embolism (PE). After multivariate adjustment, SG-IVCF was associated with significantly higher odds of unplanned intensive care unit admission, reoperation, and ED visit, but lower odds of PE. RYGB-IVCF demonstrated higher odds of reoperation but no association with PE. Both SG-IVCF and RYGB-IVCF were linked to a lower likelihood of mortality.
While IVCFs may associate with distinct outcomes by procedure, this study did not indicate a clear protective effect, instead demonstrating an association with greater postoperative morbidity after risk adjustment.
下腔静脉滤器（IVCFs）用于降低减肥手术后血栓栓塞并发症的发生率。
本研究比较了在袖状胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）时存在或不存在IVCFs的患者的30天结局。
向2018 - 2021年代谢和减肥手术认证与质量改进计划数据库报告的患者。
确定接受初次SG或RYGB的成年人，分别存在或不存在IVCFs（分别为SG-IVCF和仅SG或RYGB-IVCF和仅RYGB）。使用熵平衡对每个手术的IVCF状态的基线特征进行调整。随后进行多变量加权逻辑回归和线性回归，以评估减肥手术时IVCF的存在与感兴趣结局之间的独立关联。
在纳入的721,161例患者中，71.9%（n = 518,454）接受了SG，28.1%（n = 202,707）接受了RYGB，其中分别有0.3%（n = 1471）和0.3%（n = 643）存在IVCFs。与仅SG和仅RYGB相比，SG-IVCF和RYGB-IVCF的未调整深静脉血栓形成30天发生率更高，而只有RYGB-IVCF的肺栓塞（PE）发生率更高。多变量调整后，SG-IVCF与计划外重症监护病房入院、再次手术和急诊就诊的显著较高几率相关，但PE几率较低。RYGB-IVCF显示再次手术的几率较高，但与PE无关。SG-IVCF和RYGB-IVCF均与较低的死亡可能性相关。
虽然IVCFs可能因手术不同而与不同结局相关，但本研究未表明有明确的保护作用，反而显示在风险调整后与更高的术后发病率相关。
