| Popis: |
Introduction: Although chemical prophylaxis is important in decreasing the risk of venous thromboembolism (VTE) after bariatric surgery, it may increase the rate of postoperative bleeding. The Michigan Bariatric Surgical Consortium (MBSC) recommends preoperative chemical prophylaxis administration and reports compliance to this measure in Pay for Performance standards. Methods: A retrospective review of patients who underwent laparoscopic sleeve gastrectomy (LSG) from August 2011 until November of 2014 was done. Three different regimens were utilized for prophylaxis on the day of surgery: Group A received lovenox 12 hours postoperatively, Group B received lovenox both preoperatively and 12 hours postoperatively, and Group C received lovenox preoperatively but not a second dose 12 hours postoperatively. Patients continued to receive lovenox every 12 hours from postoperative day 1 until discharge unless they bled. Tisseel fibrin sealant (Baxter) without buttressing was used along the gastric staple line in all cases. Results: 781 patients underwent LSG in the indicated time period: seven in Group A (420 total patients) bled (1.7%), ten in Group B (223) bled (4.5%), while five in Group C (138) bled (3.6%) (p1⁄40.05; A versus B and C). The packed red blood cell (PRBC) transfusion for Group A was 2 þ/1.1 units, Group B was 2.7 þ/1.5 units, and Group C was 1.6 þ/0.9 units (p1⁄4NS). One patient in Group C required laparoscopic reoperation for bleeding at the gastric staple line. VTE occurred in three patients: two in Group A (0.48%) and one in Group B or C (0.28%) (p1⁄4NS). The length of stay was significantly (p1⁄40.0001) longer in patients who required PRBC transfusion (mean 3.5 þ/1.1 days) versus those who did not (mean 2.2 þ/0.5 days). No leaks or mortality occurred. Conclusion: The addition of preoperative lovenox administration did not significantly decrease the rate of VTE, however, it significantly increased the rate of postoperative bleeding and length of stay. Recommendations to administer preoperative chemical VTE prophylaxis should be revisited. A125 |
