Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery
Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death. Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence. Prospective, statewide bariatric-specific clinical re...
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| Veröffentlicht in: | Surgery for obesity and related diseases 2022-12, Vol.18 (12), p.1385-1391 |
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| creator | Carlin, Arthur M. Varban, Oliver A. Ehlers, Anne P. Bonham, Aaron J. Ghaferi, Amir A. Finks, Jonathan F. |
| description | Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death.
Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence.
Prospective, statewide bariatric-specific clinical registry.
We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT.
A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64–5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36–4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98–30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65–33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76–22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57–16.06; P < .0001).
Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.
[Display omitted]
•PVT is now the most common VTE event following bariatric surgery in Michigan•Preoperative predictors of PVT include prior VTE and liver disorder•Other predictors of PVT include sleeve gastrectomy and surgical complications•Most PVTs occur between the 2nd and 4th postoperative weeks |
| doi_str_mv | 10.1016/j.soard.2022.07.016 |
| format | Article |
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Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence.
Prospective, statewide bariatric-specific clinical registry.
We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT.
A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64–5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36–4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98–30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65–33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76–22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57–16.06; P < .0001).
Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.
[Display omitted]
•PVT is now the most common VTE event following bariatric surgery in Michigan•Preoperative predictors of PVT include prior VTE and liver disorder•Other predictors of PVT include sleeve gastrectomy and surgical complications•Most PVTs occur between the 2nd and 4th postoperative weeks</description><identifier>ISSN: 1550-7289</identifier><identifier>EISSN: 1878-7533</identifier><identifier>DOI: 10.1016/j.soard.2022.07.016</identifier><identifier>PMID: 36198496</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aftercare ; Bariatric surgery ; Bariatric Surgery - adverse effects ; Bariatric Surgery - methods ; Chemoprophylaxis ; Gastrectomy - adverse effects ; Gastrectomy - methods ; Humans ; Hypercoagulable ; Laparoscopy - methods ; Liver disease ; Mesenteric Veins ; Obesity, Morbid - complications ; Patient Discharge ; Portal Vein ; Portomesenteric vein thrombosis ; Postoperative complications ; Postoperative Complications - epidemiology ; Prospective Studies ; Sleeve gastrectomy ; Venous thromboembolism ; Venous Thromboembolism - etiology ; Venous Thrombosis - drug therapy ; Venous Thrombosis - epidemiology ; Venous Thrombosis - etiology</subject><ispartof>Surgery for obesity and related diseases, 2022-12, Vol.18 (12), p.1385-1391</ispartof><rights>2022 American Society for Metabolic and Bariatric Surgery</rights><rights>Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-bddf0688767c0a8d6f3dfd43449dd28f318a63ae5897b5296c46d001834ec9f43</citedby><cites>FETCH-LOGICAL-c359t-bddf0688767c0a8d6f3dfd43449dd28f318a63ae5897b5296c46d001834ec9f43</cites><orcidid>0000-0001-5469-3138</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.soard.2022.07.016$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36198496$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carlin, Arthur M.</creatorcontrib><creatorcontrib>Varban, Oliver A.</creatorcontrib><creatorcontrib>Ehlers, Anne P.</creatorcontrib><creatorcontrib>Bonham, Aaron J.</creatorcontrib><creatorcontrib>Ghaferi, Amir A.</creatorcontrib><creatorcontrib>Finks, Jonathan F.</creatorcontrib><title>Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery</title><title>Surgery for obesity and related diseases</title><addtitle>Surg Obes Relat Dis</addtitle><description>Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death.
Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence.
Prospective, statewide bariatric-specific clinical registry.
We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT.
A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64–5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36–4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98–30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65–33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76–22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57–16.06; P < .0001).
Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.
[Display omitted]
•PVT is now the most common VTE event following bariatric surgery in Michigan•Preoperative predictors of PVT include prior VTE and liver disorder•Other predictors of PVT include sleeve gastrectomy and surgical complications•Most PVTs occur between the 2nd and 4th postoperative weeks</description><subject>Aftercare</subject><subject>Bariatric surgery</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Bariatric Surgery - methods</subject><subject>Chemoprophylaxis</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastrectomy - methods</subject><subject>Humans</subject><subject>Hypercoagulable</subject><subject>Laparoscopy - methods</subject><subject>Liver disease</subject><subject>Mesenteric Veins</subject><subject>Obesity, Morbid - complications</subject><subject>Patient Discharge</subject><subject>Portal Vein</subject><subject>Portomesenteric vein thrombosis</subject><subject>Postoperative complications</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prospective Studies</subject><subject>Sleeve gastrectomy</subject><subject>Venous thromboembolism</subject><subject>Venous Thromboembolism - etiology</subject><subject>Venous Thrombosis - drug therapy</subject><subject>Venous Thrombosis - epidemiology</subject><subject>Venous Thrombosis - etiology</subject><issn>1550-7289</issn><issn>1878-7533</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtKxTAQhoMo3p9AkC7dtObSJunChYg3ENzoTghpMtEcTpua5Ai-vTkedekmE_75JkM-hE4Ibggm_HzRpKCjbSimtMGiKdkW2idSyFp0jG2Xe9fhWlDZ76GDlBYYM94Juov2GCe9bHu-j17uJwszlGPK1RzBepNDTJWebJX96KfXKrhqDjGHEVKBIHpTfYCfqvwWwziE5AvtSl4NOnqd1_20iq8QP4_QjtPLBMc_9RA931w_Xd3VD4-391eXD7VhXZ_rwVqHuZSCC4O1tNwx62zL2ra3lkrHiNScaehkL4aO9ty03GJMJGvB9K5lh-hs8-4cw_sKUlajTwaWSz1BWCVFBaWMUCzXKNugJoaUIjg1Rz_q-KkIVmutaqG-taq1VoWFKlmZOv1ZsBpGsH8zvx4LcLEBoHzzw0NUyXiYTPEZwWRlg_93wRfDOovW</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Carlin, Arthur M.</creator><creator>Varban, Oliver A.</creator><creator>Ehlers, Anne P.</creator><creator>Bonham, Aaron J.</creator><creator>Ghaferi, Amir A.</creator><creator>Finks, Jonathan F.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5469-3138</orcidid></search><sort><creationdate>202212</creationdate><title>Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery</title><author>Carlin, Arthur M. ; Varban, Oliver A. ; Ehlers, Anne P. ; Bonham, Aaron J. ; Ghaferi, Amir A. ; Finks, Jonathan F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-bddf0688767c0a8d6f3dfd43449dd28f318a63ae5897b5296c46d001834ec9f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aftercare</topic><topic>Bariatric surgery</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Bariatric Surgery - methods</topic><topic>Chemoprophylaxis</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastrectomy - methods</topic><topic>Humans</topic><topic>Hypercoagulable</topic><topic>Laparoscopy - methods</topic><topic>Liver disease</topic><topic>Mesenteric Veins</topic><topic>Obesity, Morbid - complications</topic><topic>Patient Discharge</topic><topic>Portal Vein</topic><topic>Portomesenteric vein thrombosis</topic><topic>Postoperative complications</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prospective Studies</topic><topic>Sleeve gastrectomy</topic><topic>Venous thromboembolism</topic><topic>Venous Thromboembolism - etiology</topic><topic>Venous Thrombosis - drug therapy</topic><topic>Venous Thrombosis - epidemiology</topic><topic>Venous Thrombosis - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carlin, Arthur M.</creatorcontrib><creatorcontrib>Varban, Oliver A.</creatorcontrib><creatorcontrib>Ehlers, Anne P.</creatorcontrib><creatorcontrib>Bonham, Aaron J.</creatorcontrib><creatorcontrib>Ghaferi, Amir A.</creatorcontrib><creatorcontrib>Finks, Jonathan F.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery for obesity and related diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carlin, Arthur M.</au><au>Varban, Oliver A.</au><au>Ehlers, Anne P.</au><au>Bonham, Aaron J.</au><au>Ghaferi, Amir A.</au><au>Finks, Jonathan F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery</atitle><jtitle>Surgery for obesity and related diseases</jtitle><addtitle>Surg Obes Relat Dis</addtitle><date>2022-12</date><risdate>2022</risdate><volume>18</volume><issue>12</issue><spage>1385</spage><epage>1391</epage><pages>1385-1391</pages><issn>1550-7289</issn><eissn>1878-7533</eissn><abstract>Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death.
Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence.
Prospective, statewide bariatric-specific clinical registry.
We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT.
A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64–5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36–4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98–30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65–33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76–22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57–16.06; P < .0001).
Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.
[Display omitted]
•PVT is now the most common VTE event following bariatric surgery in Michigan•Preoperative predictors of PVT include prior VTE and liver disorder•Other predictors of PVT include sleeve gastrectomy and surgical complications•Most PVTs occur between the 2nd and 4th postoperative weeks</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36198496</pmid><doi>10.1016/j.soard.2022.07.016</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-5469-3138</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aftercare Bariatric surgery Bariatric Surgery - adverse effects Bariatric Surgery - methods Chemoprophylaxis Gastrectomy - adverse effects Gastrectomy - methods Humans Hypercoagulable Laparoscopy - methods Liver disease Mesenteric Veins Obesity, Morbid - complications Patient Discharge Portal Vein Portomesenteric vein thrombosis Postoperative complications Postoperative Complications - epidemiology Prospective Studies Sleeve gastrectomy Venous thromboembolism Venous Thromboembolism - etiology Venous Thrombosis - drug therapy Venous Thrombosis - epidemiology Venous Thrombosis - etiology |
| title | Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery |
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