Risk factors for postoperative bleeding in bariatric surgery.

Autor:	Straatman J; Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands. Electronic address: jstraatman@rkz.nl., Verhaak T; Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands., Demirkiran A; Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands., Harlaar NJ; Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands., Cense HA; Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands., Jonker FHW; Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands.
Jazyk:	angličtina
Zdroj:	Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2022 Aug; Vol. 18 (8), pp. 1057-1065. Date of Electronic Publication: 2022 May 18.
DOI:	10.1016/j.soard.2022.05.010
Abstrakt:	Background: Postoperative bleeding remains a relatively common complication following bariatric surgery and may lead to morbidity and even mortality. Objective: To develop a prediction model to identify patients at risk for postoperative bleeding. Setting: Rode Kruis Ziekenhuis, Beverwijk, the Netherlands. Based on Dutch nationwide obesity audit data. Methods: Patients undergoing primary bariatric surgery were selected from January 2015 to December 2020 from the Dutch Audit for Treatment of Obesity. The primary outcome was postoperative bleeding within 30 days. Assessed predictors included patient factors and operative data. A prediction model was developed using backward stepwise logistic regression. Internal validation was performed using bootstrapping techniques. Results: A total of 59,055 patients were included; 13,399 underwent a sleeve gastrectomy, and 45,656 underwent a gastric bypass procedure. Postoperative bleeding occurred in 1.5%. The following predictors were identified: male patients (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.21-1.63), patients >45 years of age (OR = 1.50; 95% CI: 1.29-1.76), body mass index <40 kg/m 2 (OR = 1.22; 95% CI: 1.06-1.41), cardiovascular disease (OR = 1.36; 95% CI: 1.17-1.57), and sleeve gastrectomy (OR = 1.43; 95% CI: 1.24-1.67). Area under the curve for the model was .612. Following bootstrapping for internal validation, a correction of .9817 was applied. Conclusion: A clinical decision rule was designed to assess the risk of postoperative bleeding in patients undergoing bariatric surgery. If 3 or more risk factors are present, there is an increased risk for postoperative bleeding. The model can aid in clinical decision-making: implementing extra preventative measures in high-risk patients. External validation is needed to further develop the model. (Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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