Factors Associated with Increased Risk for Pulmonary Embolism After Metabolic and Bariatric Surgery: Analysis of Nearly One Million Patients.

BACKGROUND: Metabolic and bariatric surgery (MBS) has a low incidence of post-operative morbidity and mortality. Understanding risk factors associated with complications that occur allows surgeons to define at-risk patients and assess the need for preventive and prophylactic measures. OBJECTIVES: To determine risk factors associated with development of pulmonary embolism (PE) within 30 days of MBS and to predict the increased risk for mortality when PE occurs. SETTING: USA, MBSAQIP database. METHODS: Analysis of the MBSAQIP database was undertaken. This included information on 966,646 MBS cases from 2015 to 2019 in the USA. RESULTS: Twenty-two risk factors for development of PE post-MBS were identified to be statistically significant. CONCLUSIONS: PE is a relatively uncommon complication after MBS. When it does occur, there is a 50.9-fold increased risk for mortality. Patients with significant risk factors for PE may benefit from higher dose perioperative and/or extended VTE prophylaxis after MBS.

Robotic vs. Laparoscopic Metabolic and Bariatric Surgery, Outcomes over 5 Years in Nearly 800,000 Patients.

INTRODUCTION: Studies assessing outcomes between laparoscopic and robotic bariatric metabolic surgery (BMS) have been limited by the relatively small percentage of robotic cases. However, in recent years, the number of robotic BMS cases has doubled. We report the largest US study comparing robotic versus laparoscopic outcomes in BMS over the longest time period (5 years). METHODS: Analysis of the MBSAQIP database was undertaken. This included information on 791,423 patients from 2015-2019 in the USA. Within this retrospective case-control study, 13.7% of SG and 16.6% of RYGB cases were done robotically. SETTING: USA, MBSAQIP database. RESULTS: Robotic BMS increased mean operative time by 26 min for SG and 40 min for RYGB. However, this did not increase the 30-day venous thromboembolism (VTE) or organ dysfunction complications between the 2 groups. Robotic SG had slightly higher risks of multiple infectious complications (OR 1.26 to 1.76). Robotic RYGB had slightly lower infectious complications and transfusion requirements. Robotic BMS had higher 30-day readmission rates and 30-day reoperative rates for both SG and RYGB. CONCLUSIONS: Both robotic SG and RYGB were found to have significantly longer operative times than laparoscopic SG and RYGB. Potential outcome benefits from robotic BMS can include a reduction in infectious complications and transfusion requirements with robotic RYGB cases. SGs were found to have slightly higher infectious complications.