Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the Bariatric Outcomes Longitudinal Database

Abstract

Introduction: Postoperative pulmonary embolism (PE) is a leading cause of morbidity and mortality after bariatric surgery. However, the concurrent prophylactic placement of an inferior vena cava filter (CPIVCF) in patients undergoing bariatric operations remains controversial. This study used the Bariatric Outcomes Longitudinal Database (BOLD) to establish associated characters and determine outcomes of CPIVCF for patients undergoing Roux-en-Y gastric bypass (GB) and adjustable gastric banding (AB) surgeries. Methods: We analyzed BOLD, a database of bariatric surgery patient information. GB and AB operations were categorized into open and laparoscopic approaches. Univariate logistic regressions were used to compare between non-CPIVCF and concurrent CPIVCF groups. Significant variables (P < .05) were subsequently input into multivariate regression models: CPIVCF was retained in each model. Results: A total of 322 CPIVCFs (0.33%) were identified from 97,218 GB and AB operations performed between 2007 and 2010 in this retrospective registry study. Significant differences were identified in male gender (21.1% vs 31.4%; P < .001), preoperative body mass index (BMI; 44.5 ؎ 6.6 vs 45.3 ؎ 7; P < .001), and African-American race (10.5% vs 18%; P < .001) between non-CPIVCF and CPIVCF groups. The CPIVCF group had more patients with previous nonbariatric surgery (50% vs 43.6%; P ‫؍‬ .02), a history of venous thromboembolism (VTE; 21.4% vs 3.1%; P < .001), impairment of functional status (7.8% vs 3.1%; P < .001), lower extremity edema (47.2% vs 27.1%; P < .001), obesity hypoventilation syndrome (7.1% vs 2.1%; P < .001), obstructive sleep apnea syndrome (58.1% vs 43.3%; P < .001), and pulmonary hypertension (13% vs 4.1%; P < .001). Patients in the CPIVCF group were more likely to receive GB than gastric banding (77% vs 58.1%; P < .001) and an open surgical approach (21.4% vs 4.8%; P < .001). Operative duration was longer in the CPIVCF group (119 ؎ 67 vs 89 ؎ 52 minutes; P < .001). The CPIVCF group also had a longer length of hospital stay (3 ؎ 2 vs 2 ؎ 6 days; P ‫؍‬ .048), was associated with higher incidence of deep venous thrombosis (DVT; 0.93% vs 0.12%; P < .001), and had a higher mortality (0.31% vs 0.03%; P ‫؍‬ .003) from PE and indeterminate causes. In multivariate analysis, male gender, African-American race, previous nonbariatric surgery, a high BMI, obesity hypoventilation syndrome, history of VTE, lower extremity edema, and pulmonary hypertension were preoperative factors associated with CPIVCF. Conclusions: CPIVCF was associated with specific clinical features, increased health care resource utilization, and a higher mortality in patients undergoing bariatric operations. Although selected patient characteristics influence surgeons to perform CPIVCF, this study was unable to establish an outcome benefit for CPIVCF. ( J Vasc Surg 2012;55:1690-5.)

Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis

“…Of the 701 selected abstracts, we included 6 studies (n=102767) for the quantitative synthesis ( Figure 1) [7][8][9][10][11][12] . Studies were published between 2006 and 2013, and all patients underwent bariatric surgery ( Table 1).…”

“…It is possible, even though only one study [10] adjusted for important differences between the groups, that some of these patients may be sicker at baseline compared to those obese patients where the surgeon did not consider the placement of an IVC filter before surgery. For example, some of the patients belonging to these groups could be older, more obese, have a greater limitation in functional status and longer duration of surgery.…”

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

“…We identified 2 systematic reviews of RCTs and observational studies 137,138 that addressed this research question in bariatric surgery and trauma patients. We identified 14 studies [139][140][141][142][143][144][145][146][147][148][149][150][151][152] in these reviews that fulfilled our inclusion criteria and measured outcomes relevant to this context. Our search for RCTs and observational studies identified 1 additional study that fulfilled the inclusion criteria.…”

Pulmonary embolism and fatal stroke in a patient with severe factor XI deficiency after bariatric surgery

“…Maybe we could have used a combined drug and mechanical thromboprophylaxis strategy as it was done recently for a hip arthroplasty in a severe FXIdeficient patient using Hemoleven [27]. Regarding the placement of inferior vena cava filter for primary prophylaxis, several nonrandomized trials did not show a significant difference in rates of VTE [28][29][30][31], expect one. In the latest issue of Chest from the American College of Chest Physicians [17], it is stated that 'for abdominal-pelvic patients we suggest that an inferior cava filter should not be used for primary prevention (grade 2C)'.…”