Is staple line oversewing in patients on chronic anticoagulation during laparoscopic sleeve gastrectomy necessary? Propensity score matching analysis using the 2015-2018 MBSAQIP.
Humans
Adolescent
Young Adult
Adult
Middle Aged
Aged
Obesity, Morbid
/ surgery
Propensity Score
Laparoscopy
/ adverse effects
Gastrectomy
/ adverse effects
Surgical Stapling
/ methods
Postoperative Hemorrhage
/ epidemiology
Anticoagulants
/ adverse effects
Postoperative Complications
/ epidemiology
Treatment Outcome
Retrospective Studies
Bariatric surgery
Chronic anticoagulation
Laparoscopic sleeve gastrectomy
Minimally invasive surgery
Staple line oversewing
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
16
09
2021
accepted:
15
02
2022
pubmed:
1
3
2022
medline:
1
11
2022
entrez:
28
2
2022
Statut:
ppublish
Résumé
There is an increased incidence of post-operative bleeding in patients on chronic anticoagulation (CAC). This incited some surgeons to oversew the sleeve staple line as a potentially preventive measure for post-operative bleeding. However, there is no clear evidence to assess the effectiveness of staple line oversewing during laparoscopic sleeve gastrectomy (LSG) in patients with CAC. Using the 2015-2018 metabolic and bariatric surgery accreditation and quality improvement program database, patients between ages 18 and 65 who underwent LSG were included. To investigate the role of CAC, we performed 1:1 propensity score matching (PSM) between the CAC and non-CAC patients. Then, to explore the impact of oversewing, we focused on the CAC patients and divided them into 2 subgroups: oversewing versus non-oversewing. PSM was also performed to compare both subgroups. To avoid confounders, both PSM analyses were performed using 22 preoperative characteristics. 30-day postoperative outcomes including bleeding and blood transfusion requirement were assessed. 402,826 patients underwent LSG. 9148 patients (2.3%) were on CAC. In the CAC cohort (8843 matched cases), the anticoagulated patients showed significant increase in postoperative bleeding (1.2% vs. 0.5%; P < 0.001), blood transfusion requirements (1.7% vs. 0.7%; P < 0.001), unplanned ICU admissions (2.0% vs. 1.3%; P = 0.001), interventions (2.0% vs. 1.5%; P = 0.015), and readmissions (6.2% vs. 4.7%; P < 0.001). 1939 (21.2%) patients on CAC underwent oversewing during the LSG. The operative time was significantly longer in these patients (87.11 ± 40 vs. 76.19 ± 37; P < 0.001). Patients who underwent oversewing showed similar results in 30-day outcomes as those who did not, with no statistical difference, including postoperative bleeding (1.0% vs. 0.9%; P = 0.8) and blood transfusion requirements (1.4% vs. 1.8%; P = 0.9). Incidences of post-operative bleeding and blood transfusion requirements are higher in patients on CAC during the LSG. Oversewing the sleeve staple line leads to longer operative times without additional benefit in 30-day outcomes.
Sections du résumé
BACKGROUND
There is an increased incidence of post-operative bleeding in patients on chronic anticoagulation (CAC). This incited some surgeons to oversew the sleeve staple line as a potentially preventive measure for post-operative bleeding. However, there is no clear evidence to assess the effectiveness of staple line oversewing during laparoscopic sleeve gastrectomy (LSG) in patients with CAC.
METHODS
Using the 2015-2018 metabolic and bariatric surgery accreditation and quality improvement program database, patients between ages 18 and 65 who underwent LSG were included. To investigate the role of CAC, we performed 1:1 propensity score matching (PSM) between the CAC and non-CAC patients. Then, to explore the impact of oversewing, we focused on the CAC patients and divided them into 2 subgroups: oversewing versus non-oversewing. PSM was also performed to compare both subgroups. To avoid confounders, both PSM analyses were performed using 22 preoperative characteristics. 30-day postoperative outcomes including bleeding and blood transfusion requirement were assessed.
RESULTS
402,826 patients underwent LSG. 9148 patients (2.3%) were on CAC. In the CAC cohort (8843 matched cases), the anticoagulated patients showed significant increase in postoperative bleeding (1.2% vs. 0.5%; P < 0.001), blood transfusion requirements (1.7% vs. 0.7%; P < 0.001), unplanned ICU admissions (2.0% vs. 1.3%; P = 0.001), interventions (2.0% vs. 1.5%; P = 0.015), and readmissions (6.2% vs. 4.7%; P < 0.001). 1939 (21.2%) patients on CAC underwent oversewing during the LSG. The operative time was significantly longer in these patients (87.11 ± 40 vs. 76.19 ± 37; P < 0.001). Patients who underwent oversewing showed similar results in 30-day outcomes as those who did not, with no statistical difference, including postoperative bleeding (1.0% vs. 0.9%; P = 0.8) and blood transfusion requirements (1.4% vs. 1.8%; P = 0.9).
CONCLUSION
Incidences of post-operative bleeding and blood transfusion requirements are higher in patients on CAC during the LSG. Oversewing the sleeve staple line leads to longer operative times without additional benefit in 30-day outcomes.
Identifiants
pubmed: 35226162
doi: 10.1007/s00464-022-09146-5
pii: 10.1007/s00464-022-09146-5
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
8481-8489Informations de copyright
© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
Références
Arroyo-Johnson C, Mincey KD (2016) Obesity epidemiology worldwide. Gastroenterol Clin N Am 45:571–579
doi: 10.1016/j.gtc.2016.07.012
Stein PD, Beemath A, Olson RE (2005) Obesity as a risk factor in venous thromboembolism. Am J Med 118:978–980
doi: 10.1016/j.amjmed.2005.03.012
pubmed: 16164883
Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS (2008) Atrial fibrillation and obesity–results of a meta-analysis. Am Heart J 155:310–315. https://doi.org/10.1016/j.ahj.2007.10.004
doi: 10.1016/j.ahj.2007.10.004
pubmed: 18215602
Kumar SB, Hamilton BC, Wood SG, Rogers SJ, Carter JT, Lin MY (2018) Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis 14:264–269
doi: 10.1016/j.soard.2017.12.011
pubmed: 29519658
Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J, Schiesser M, Nett P, Bueter M (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319:255–265. https://doi.org/10.1001/jama.2017.20897
doi: 10.1001/jama.2017.20897
pubmed: 29340679
pmcid: 5833546
Salminen P, Helmiö M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, Hurme S, Soinio M, Nuutila P, Victorzon M (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA 319:241–254. https://doi.org/10.1001/jama.2017.20313
doi: 10.1001/jama.2017.20313
pubmed: 29340676
pmcid: 5833550
Husain F, Jeong IH, Spight D, Wolfe B, Mattar SG (2018) Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res 95:100–110. https://doi.org/10.4174/astr.2018.95.2.100
doi: 10.4174/astr.2018.95.2.100
pubmed: 30079327
pmcid: 6073041
Altieri MS, Yang J, Zhu C, Konstantinos Spaniolas L, Talamini MA, Pryor AD (2020) Preoperative anticoagulation in patients undergoing bariatric surgery is associated with worse outcomes. Surg Endosc 34:4177–4184. https://doi.org/10.1007/s00464-019-07191-1
doi: 10.1007/s00464-019-07191-1
pubmed: 31617101
Taha O, Abdelaal M, Talaat M, Abozeid M (2018) A randomized comparison between staple-line oversewing versus no reinforcement during laparoscopic vertical sleeve gastrectomy. Obes Surg 28:218–225. https://doi.org/10.1007/s11695-017-2835-y
doi: 10.1007/s11695-017-2835-y
pubmed: 28741238
Hany M, Ibrahim M (2018) Comparison between stable line reinforcement by barbed suture and non-reinforcement in sleeve gastrectomy: a randomized prospective controlled study. Obes Surg 28:2157–2164. https://doi.org/10.1007/s11695-018-3175-2
doi: 10.1007/s11695-018-3175-2
pubmed: 29508273
Wang H, Lu J, Feng J, Wang Z (2017) Staple line oversewing during laparoscopic sleeve gastrectomy. Ann R Coll Surg Engl 99:509–514. https://doi.org/10.1308/rcsann.2017.0074
doi: 10.1308/rcsann.2017.0074
pubmed: 28853595
pmcid: 5697033
Thoemmes FJ, Kim ES (2011) A systematic review of propensity score methods in the social sciences. Multivar Behav Res 46:90–118. https://doi.org/10.1080/00273171.2011.540475
doi: 10.1080/00273171.2011.540475
Sharma G, Hanipah ZN, Aminian A, Punchai S, Bucak E, Schauer PR, Brethauer SA (2018) Bariatric surgery in patients on chronic anticoagulation therapy. Obes Surg 28:2225–2232. https://doi.org/10.1007/s11695-018-3120-4
doi: 10.1007/s11695-018-3120-4
pubmed: 29455405
Berger ER, Huffman KM, Fraker T, Petrick AT, Brethauer SA, Hall BL, Ko CY, Morton JM (2018) Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg 267:122–131. https://doi.org/10.1097/SLA.0000000000002079
doi: 10.1097/SLA.0000000000002079
pubmed: 27849660
Gagner M, Kemmeter P (2020) Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 34:396–407. https://doi.org/10.1007/s00464-019-06782-2
doi: 10.1007/s00464-019-06782-2
pubmed: 30993513
Zafar SN, Felton J, Miller K, Wise ES, Kligman M (2018) Staple line treatment and bleeding after laparoscopic sleeve gastrectomy. JSLS 22(e2018):00056. https://doi.org/10.4293/JSLS.2018.00056
doi: 10.4293/JSLS.2018.00056