Background

Venous thromboembolism (VTE) is rare after bariatric surgery, but is the most common cause of mortality. The use of VTE risk stratification tools and compliance to practice guidelines remain unclear. Objective: Our objectives were to determine utilization of risk-stratified VTE prophylaxis and impact on VTE and bleeding outcomes.Setting: Academic Hospital.

Methods

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) (2016-2020) were identified from our electronic health record. Caprini score and VTE prophylaxis regimen were retrospectively determined. VTE prophylaxis was binarized as either appropriate (1) or not appropriate (0) based on Caprini score and prophylaxis regimen. Outcomes were compared between VTE prophylaxis cohorts. Variables were compared by Kruskal-Wallis or Pearson Chi-Square test. Stata/MP 16.1 was used for analysis. A p-value < 0.05 was considered significant.

Results

1528 bariatric cases were analyzed (69% RYGB). 34% received appropriate risk-stratified VTE prophylaxis (Figure 1). Median Caprini score was higher in those without appropriate prophylaxis (6.0 vs. 4.0, p < 0.0001). 30-day and 90-day VTE rates were 1% and 1.5%, respectively. 30-day (0.8% vs. 1.2%, pNS) and 90-day (1% vs. 1.8%, pNS) VTE rates were lower in those with appropriate Caprini risk-stratified VTE prophylaxis. There were no significant correlation between appropriate VTE prophylaxis and postoperative bleeding(Table1). There were 18 potentially preventable VTE events, 72% occurring in RYGB patients.

Conclusions

Caprini risk-stratified VTE prophylaxis practice resulted in lower VTE events (p NS), without bleeding risk. A larger cohort would likely show significant differences. Risk-stratified VTE prophylaxis should be considered standard of practice in bariatrics.