Background

Bariatric surgery patients are at moderate to high risk for developing venous thromboembolic (VTE) however the risk for revisional surgery lacks granularity. The objective of the present study was to define the risk of venous VTE following revisional Roux-en-Y gastric bypass (RYGB) compared to primary RYGB.

Methods

Adults who underwent either primary or revisional RYGB between January 1, 2015 and December 31, 2018 at 854 centers were identified in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. VTE was defined as pulmonary embolus (PE) and/or deep venous thrombosis (DVT). Primary endpoint included VTE events at 30 days. Secondary endpoints included bleeding rates, leaks as well as reoperations. All were compared between those who underwent primary or revisional RYGB.

Results

A total of 175,250 bariatric surgery cases were performed including 161,175 (92.0%) primary RYGB and 14,075 (8.0%) revisional RYGB. Patients in the revision group had fewer comorbid conditions and a lower mean BMI (p<0.001). Revision RYGB patients experienced higher rates of PE (0.3% vs 0.1%, p<0.001), leak (0.4% vs 0.1%, p<0.001), blood transfusions (1.8% vs 1.1%, p<0.001) and reoperations (4.3% vs 2.2%, p<0.001) compared to primary RYGB.

Conclusions

Revisional RYGB cases impose increased risk for VTE and a standardized guideline for extended VTE prophylaxis is recommended.