Comment on: Extended postoperative venous thromboembolism prophylaxis after bariatric surgery: a comparison of existing risk-stratification tools and 5-year MBSAQIP analysis.

Abstract

Venothromboembolic (VTE) events have the greatest effect on the likelihood of mortality after metabolic-bariatric surgery (MBS) [ 1 Daigle CR, Brethauer SA, Tu C, et al. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes? Google Scholar ]. A recent Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) analysis from 2015-2019 found pulmonary embolism (PE) after MBS was associated with a 50.9-fold increased risk for mortality [ 2 Vosburg R.W. Druar N.M. Kim J.J. Factors associated with increased risk for pulmonary embolism after metabolic and bariatric surgery: analysis of nearly one million patients. Obes Surg. 2022; 32: 2433-2437 Crossref PubMed Scopus (1) Google Scholar ]. The three greatest risk factors for PE were a history of PE, history of deep vein thrombosis (DVT), and oxygen-dependence [ 2 Vosburg R.W. Druar N.M. Kim J.J. Factors associated with increased risk for pulmonary embolism after metabolic and bariatric surgery: analysis of nearly one million patients. Obes Surg. 2022; 32: 2433-2437 Crossref PubMed Scopus (1) Google Scholar ]. Given the severe morbidity associated with VTE, bariatric providers are hungry for evidence-based consensus regarding VTE prophylaxis for event risk-reduction, as reduced VTE events have the greatest potential to lower mortality and readmission rates [ 1 Daigle CR, Brethauer SA, Tu C, et al. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes? Google Scholar ]. Clark et al examined the MarketScan Research database and found post-discharge chemoprophylaxis rates were 11.3% but had large state to state variation, from 0.5% to 37.4% [ 3 Clark L.N. Helm M.C. Gould J.C. Practice patters regarding post-discharge chemoprophylaxis for venous thromboembolism following bariatric surgery in the United States. Surg Obes Relat Dis. 2019; 15: 703-707 Abstract Full Text Full Text PDF PubMed Google Scholar ]. A recent survey published by the American Society for Metabolic and Bariatric Surgery (ASMBS) Research Committee found a national gap in practice consensus for extended VTE prophylaxis, with 13.7% never prescribing and 12.5% always prescribing with a large variation in duration of extended prophylaxis and indications for selective administration [ 4 Giannopoulos S. Motamedi S. Athanasiadis D.I. et al. Venous thromboembolism (VTE) prophylaxis after bariatric surgery: a national survey of MBSAQIP director practices. Surg Obes Relat Dis. 2023; S1550-7289: 00836-X Google Scholar ]. Extended postoperative venous thromboembolism prophylaxis after bariatric surgery: a comparison of existing risk-stratification tools and 5-year MBSAQIP analysisSurgery for Obesity and Related DiseasesPreviewVenous thromboembolism (VTE) is a leading cause of 30-day mortality after metabolic and bariatric surgery (MBS). Multiple predictive tools exist for VTE risk assessment and extended VTE chemoprophylaxis determination. Full-Text PDF