Arturo Estrada, Yeisson Rivero-Moreno, Jasson Xia, Diego Zamata-Ovalle, Karen Velez, Jorge Humberto Rodriguez-Quintero, Jenny Choi, Erin Moran-Atkin, Diego Camacho
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Cases were matched with controls by sex, gender, type of procedure, and ASA classification.</p><p><strong>Results: </strong>From 204 participants, 102 patients with POH were matched with 102 controls. The most common procedure performed was Roux-en-Y gastric bypass (n = 98, 48%), followed by sleeve gastrectomy (n = 77, 37.7%). Patients with POH had statistically significant lower intraoperative MAP during the last 10 min (92.41 ± 14.25 vs 97.44 ± 14.64, p = 0.014) and 30 min (87.93 ± 12.32 vs 91.93 ± 11.26, p = 0.016) of surgery compared to controls. An intraoperative MAP lower than 90 mmHg in the last 10 min (OR = 2.067, 95% CI = 1.156-3.695), 30 min (OR = 2.231, 95% CI = 1.27-3.919), and whole procedure (OR = 1.834, 95% CI = 1.024-3.285) was associated with increased risk of POH. No significant differences were found in comorbidities, smoking, preoperative laboratory results, history of antiplatelet therapy or anticoagulation use, and operative time between the two groups.</p><p><strong>Conclusion: </strong>Our study demonstrates that patients with POH had lower intraoperative MAP during the last 10 and 30 min of surgery. An intraoperative MAP < 90 mmHg was identified as a risk factor for developing POH.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The impact of reduced intraoperative mean arterial pressure on postoperative hemorrhage in bariatric surgery.\",\"authors\":\"Arturo Estrada, Yeisson Rivero-Moreno, Jasson Xia, Diego Zamata-Ovalle, Karen Velez, Jorge Humberto Rodriguez-Quintero, Jenny Choi, Erin Moran-Atkin, Diego Camacho\",\"doi\":\"10.1007/s00464-025-11841-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Postoperative hemorrhage (POH) is a life-threatening complication, occurring in 1.3-1.7% of bariatric surgeries and still constitutes a recognized challenge. This study examined the effect of intraoperative mean arterial pressure (MAP) on the development of POH.</p><p><strong>Methods: </strong>A retrospective observational study with a case-control design was conducted on adult patients who underwent bariatric surgery between 2015 and 2023 at a high-volume academic center. Intraoperative MAP (including MAP in the last 10 and 30 min) was collected in patients who developed POH. Cases were matched with controls by sex, gender, type of procedure, and ASA classification.</p><p><strong>Results: </strong>From 204 participants, 102 patients with POH were matched with 102 controls. The most common procedure performed was Roux-en-Y gastric bypass (n = 98, 48%), followed by sleeve gastrectomy (n = 77, 37.7%). Patients with POH had statistically significant lower intraoperative MAP during the last 10 min (92.41 ± 14.25 vs 97.44 ± 14.64, p = 0.014) and 30 min (87.93 ± 12.32 vs 91.93 ± 11.26, p = 0.016) of surgery compared to controls. An intraoperative MAP lower than 90 mmHg in the last 10 min (OR = 2.067, 95% CI = 1.156-3.695), 30 min (OR = 2.231, 95% CI = 1.27-3.919), and whole procedure (OR = 1.834, 95% CI = 1.024-3.285) was associated with increased risk of POH. No significant differences were found in comorbidities, smoking, preoperative laboratory results, history of antiplatelet therapy or anticoagulation use, and operative time between the two groups.</p><p><strong>Conclusion: </strong>Our study demonstrates that patients with POH had lower intraoperative MAP during the last 10 and 30 min of surgery. 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引用次数: 0
摘要
背景:术后出血(POH)是一种危及生命的并发症,发生在1.3-1.7%的减肥手术中,仍然是一个公认的挑战。本研究探讨术中平均动脉压(MAP)对POH发展的影响。方法:采用病例对照设计的回顾性观察性研究,对2015 - 2023年间在某大容量学术中心接受减肥手术的成年患者进行研究。收集POH患者术中MAP(包括最后10分钟和30分钟的MAP)。病例按性别、性别、手术类型和ASA分类与对照组相匹配。结果:从204名参与者中,102名POH患者与102名对照组相匹配。最常见的手术是Roux-en-Y胃旁路术(n = 98, 48%),其次是袖胃切除术(n = 77, 37.7%)。POH患者术中MAP在手术最后10 min(92.41±14.25 vs 97.44±14.64,p = 0.014)和30 min(87.93±12.32 vs 91.93±11.26,p = 0.016)均低于对照组,具有统计学意义。术中MAP在最后10分钟(OR = 2.067, 95% CI = 1.156-3.695)、30分钟(OR = 2.231, 95% CI = 1.27-3.919)和整个手术过程(OR = 1.834, 95% CI = 1.024-3.285)低于90 mmHg与POH风险增加相关。两组在合并症、吸烟、术前实验室结果、抗血小板治疗或抗凝使用史、手术时间等方面均无显著差异。结论:我们的研究表明,POH患者在手术最后10分钟和30分钟的术中MAP较低。术中MAP
The impact of reduced intraoperative mean arterial pressure on postoperative hemorrhage in bariatric surgery.
Background: Postoperative hemorrhage (POH) is a life-threatening complication, occurring in 1.3-1.7% of bariatric surgeries and still constitutes a recognized challenge. This study examined the effect of intraoperative mean arterial pressure (MAP) on the development of POH.
Methods: A retrospective observational study with a case-control design was conducted on adult patients who underwent bariatric surgery between 2015 and 2023 at a high-volume academic center. Intraoperative MAP (including MAP in the last 10 and 30 min) was collected in patients who developed POH. Cases were matched with controls by sex, gender, type of procedure, and ASA classification.
Results: From 204 participants, 102 patients with POH were matched with 102 controls. The most common procedure performed was Roux-en-Y gastric bypass (n = 98, 48%), followed by sleeve gastrectomy (n = 77, 37.7%). Patients with POH had statistically significant lower intraoperative MAP during the last 10 min (92.41 ± 14.25 vs 97.44 ± 14.64, p = 0.014) and 30 min (87.93 ± 12.32 vs 91.93 ± 11.26, p = 0.016) of surgery compared to controls. An intraoperative MAP lower than 90 mmHg in the last 10 min (OR = 2.067, 95% CI = 1.156-3.695), 30 min (OR = 2.231, 95% CI = 1.27-3.919), and whole procedure (OR = 1.834, 95% CI = 1.024-3.285) was associated with increased risk of POH. No significant differences were found in comorbidities, smoking, preoperative laboratory results, history of antiplatelet therapy or anticoagulation use, and operative time between the two groups.
Conclusion: Our study demonstrates that patients with POH had lower intraoperative MAP during the last 10 and 30 min of surgery. An intraoperative MAP < 90 mmHg was identified as a risk factor for developing POH.
期刊介绍:
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery