Actual Situation of Thromboembolic Prophylaxis in Obesity Surgery: Data of Quality Assurance in Bariatric Surgery in Germany

Abstract

Background. Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE) and pulmonary embolism (PE) in bariatric operations is discussed. Using antithrombotic prophylaxis weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk. Methods. Since 2005 the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented. The incidences of clinically diagnosed VTE or PE were derived during the in-hospital course and follow up. Results. Overall, 11,835 bariatric procedures were performed between January 2005 and December 2010. Most performed procedures were 2730 gastric banding (GB); 4901 Roux-en-Y-gastric bypass (RYGBP) procedures, and 3026 sleeve gastrectomies (SG). Study collective includes 72.5% (mean BMI 48.1 kg/m2) female and 27.5% (mean BMI 50.5 kg/m2) male patients. Incidence of VTE was 0.06% and of PE 0.08%. Conclusion. VTE prophylaxis regimen depends on BMI and the type of procedure. Despite the low incidence of VTE and PE there is a lack of evidence. Therefore, prospective randomized studies are necessary to determine the optimal VTE prophylaxis for bariatric surgical patients.

Blutungskomplikationen in der Adipositaschirurgie

“…Insbesondere liegen keine prospektiv randomisierten Studien vor, welche das Risiko einer Lungenembolie angesichts der aktuell vorliegenden Möglich-keiten einer Thromboseprophylaxe entsprechend evaluieren [26].…”

Where to Begin and Where to End? Preoperative Assessment for Patients Undergoing Metabolic Surgery

“…Obesity contributes to the thromboembolic risk of surgery, which ranges from 0.15 to 2% [22,23,24]. The low mortality of about 0.3% after metabolic surgery makes it difficult to identify the cause of death.…”

“…Due to the increased risk for thromboembolic complications in obese patients, some authors recommend the application of LMWH twice a day for patients with BMI >50, age >50 years, male sex, venous insufficiency, hypoventilation syndrome, smoking or history of thrombosis [23]. However, there is not yet enough evidence to support such aggressive prophylaxis regimens.…”

Gewachsene Erfordernisse im anspruchsvollen viszeralchirurgischen Management bei morbider Adipositas - Was muss der Viszeralchirurg wissen?

“…Zusätzlich ist aufgrund der Körperkonstitution bei morbid adipösen Patienten die Detektion von VTE erschwert und damit das Risiko thrombembolischer Komplikationen hoch. Bis dato gibt es in der Literatur keine randomisiert-kontrollierten Studien über den Zusammenhang von tiefer Venenthrombose (TVT), Lungenembolie (LE) und den verschiedenen Möglichkeiten der VTE-Prophylaxe sowohl bei adipositaschirurgischen Eingriffen als auch bei anderen Operationen an morbid adipösen Patienten [23]. Folglich existieren derzeit keine allgemeingültigen Empfehlungen oder Leitlinien zur VTEProphylaxe [24,25].…”