Back to Annual Meeting Program

Introduction: In-hospital prophylaxis against thromboembolic events (TE) is considered routine for patients after laparoscopic adjustable gastric band (LAGB) for morbid obesity due to the increased risk of TE in this patient population. However, there are limited data regarding the benefit of extending this prophylaxis beyond discharge. Utilizing the American College of Surgeons-National Surgery Quality Improvement Project (ACS-NSQIP) database, we analyzed patients undergoing LAGB to determine the incidence of pre- and post-discharge TE and associated risk factors.

Methods: Patients undergoing LAGB between 2005-2009 were identified from the public use file of the ACS-NSQIP database using the Current Procedural Terminology code for LAGB. Univariate comparison and regression analysis of demographics and comorbidities of patients with and without TE were performed to determine independent risk factors for the development of TE.

Results: During the study period, 16,015 patients underwent LGB, of whom 19 (0.12%) developed a TE (10 (0.062%) developed a pulmonary embolus, 11 (0.069%) developed a deep-vein thrombosis, and 2 developed both) within 30 days of surgery. Eighty percent of the pulmonary embolisms and ninety-one percent of the deep venous thromboses were diagnosed after discharge. On regression analysis several patient characteristics, medical comorbidities and postoperative complications were independently associated with increased risk of TE. (Table)

Conclusion: The 30-day incidence of thromboembolic events after LAGB in ACS-NSQIP hospitals is exceedingly low, although the majority of these events occur following discharge. Certain patients are at higher risk for TE, and may represent a cohort that could benefit from extended post-operative prophylaxis.

Risk Factor	Odds Ratio	P-value
Transfusion in OR	101.24	<0.0001
Cardiac Complications Excluding PE	27.95	<0.0001
Reoperation	17.71	<0.0001
Non-caucasian	3.28	0.01
Age >= 40 years	6.27	0.02
OR Time	2.58	0.05

Significant Independent Risk Factors After LAGB