SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Pulmonary embolism (PE) remains the second leading cause of mortality after anastomotic leak, accounting for almost 40% of perioperative deaths after Bariatric surgery. Placement of prophylactic inferior vena cava (IVC) filter before bariatric surgery among certain groups of patients, to improve outcomes has shown varied results.
METHODS: A comprehensive literature search was conducted by three investigators independently in Pubmed-MEDLINE, the Web of Science and Scopus until February 28, 2013. Our search was restricted to observational studies in adult patients, published in any language. All studies with patients undergoing bariatric surgery with and without IVC filters were included. Primary outcomes of interest were postoperative deep vein thrombosis (DVT), (PE), venous thromboembolism (VTE) (either DVT or PE) and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity, and Mantel-Haenszel method to account for scarcity of outcomes. Associations are shown as Risk Ratios (RR) and 95% Confidence Intervals (CI).
RESULTS: Seven observational studies were chosen (n=102,767), with reported prevalences of DVT (0.2%), PE (0.2%), VTE (0.3%)and mortality (0.1%). The risk of DVT was significantly increased with use of IVC filters in comparison to non-use of IVC filters (RR 2.85, 95%CI 1.44-5.66, p=0.003). The risk of PE however, was not increased with the use of IVC filters (RR 1.05, 95%CI 0.37-2.99, p=0.9). This was translated into a non-significant higher risk of the composite VTE (RR 1.56, 95%CI 0.66-3.69, p=0.3 and HR 2.08, 95%CI 0.68-6.32, p=0.2). Mortality was significantly increased with the use of IVC filters (RR 3.42, 95%CI 1.15-10.19, p=0.04). Moderate to high heterogeneity of effects was noted across studies.
CONCLUSIONS: Placement of IVC filter before Bariatric surgery, infact increases the risk of postoperatiive DVT, VTE and mortality. No change was noted in the risk of Pulmonary Embolism
CLINICAL IMPLICATIONS: Empiric placement of IVC filters before Bariatric surgery in high risk patients can worsen VTE related outcomes and should be discontinued for lack of good evidence.
DISCLOSURE: The following authors have nothing to disclose: Roop Kaw, Vinay Pasupuleti, Deshpande Abhishek, Kunjam Modha, Adrian Hernandez
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