Early postoperative COVID infection is associated with significantly increased risk of venous thromboembolism after metabolic and bariatric surgery

Andrew P Sanders; R Wesley Vosburg

doi:10.1016/j.soard.2024.01.021

Early postoperative COVID infection is associated with significantly increased risk of venous thromboembolism after metabolic and bariatric surgery

Surg Obes Relat Dis. 2024 Feb 8:S1550-7289(24)00046-7. doi: 10.1016/j.soard.2024.01.021. Online ahead of print.

Authors

Andrew P Sanders¹, R Wesley Vosburg²

Affiliations

¹ Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
² Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts. Electronic address: wesvosburg@gmail.com.

PMID: 38556419
DOI: 10.1016/j.soard.2024.01.021

Abstract

Background: Patients who undergo metabolic and bariatric surgery (MBS) are at risk for thromboembolism. Patients are susceptible to coronavirus throughout the perioperative period, which also has a well-known association with thrombotic complications.

Objectives: To identify and define the association between venous thromboembolism (VTE) and postoperative coronavirus diagnosis in bariatric surgery patients.

Setting: United States.

Methods: We conducted a retrospective cohort study using the MBS Accreditation and Quality Improvement Program (MBSAQIP) 2021 database to analyze the incidence of VTE within 30 days of surgery. VTE was a composite variable defined as either postoperative pulmonary embolism or postoperative venous thrombus requiring treatment. Cohorts were stratified by whether the patient was diagnosed with postoperative coronavirus. We created a multivariable logistic regression model to determine the adjusted odds of postoperative VTE based on various factors. Additionally, we conducted subset analyses of sleeve gastrectomy and Roux-en-Y bypass cases, the 2 most frequent bariatric operations in the United States.

Results: Patients diagnosed with postoperative coronavirus were significantly more likely to develop postoperative VTE (1.1% versus .3%, P < .001). In our logistic regression model, the adjusted odds of postoperative VTE for patients with postoperative coronavirus was 3.55 (95% CI: 2.15-5.87, P < .001). For patients who underwent Roux-en-Y bypass, the adjusted odds was even greater at 5.69 (95% CI: 2.76-11.70, P < .001).

Conclusions: Early postoperative coronavirus infection after MBS is associated with higher odds of postoperative VTE. This persisted on subset analyses of the 2 most common procedures and appeared particularly important for Roux-en-Y bypass. COVID infection after MBS may warrant prolonged VTE prophylaxis.

Keywords: Coronavirus; Roux-en-Y gastric bypass; Sleeve gastrectomy; Venous thromboembolism.