Evaluating National Trends in Bleeding Associated with Metabolic Bariatric Surgery over 7 Years.

Background: Post-operative bleeding is a known complication after metabolic bariatric surgery (MBS). This study evaluates the national trends in the rates of bleeding, factors associated with bleeding, and impact of bleeding complication on other outcomes.

Methods: MBSAQIP database from 2015 to 2021 was utilized to perform multivariable regression analysis of pre-operative factors associated with bleeding for all MBS, as well as gastric bypass (RYGB) and sleeve gastrectomy (SG) subsets. Propensity matching using pre-operative factors was performed for patients with and without a bleeding complication to compare peri-operative outcomes.

Results: Rates of post-operative bleeding decreased overall from 1.01% in 2015 to 0.69% in 2021. RYGB (OR 2.08, p < 0.01) had a higher risk of bleeding compared to SG. Open surgical approach (OR 2.33, p < 0.01), therapeutic anticoagulation (OR 2.49, p < 0.01), renal insufficiency (OR 1.61, p < 0.01), and history of MI (OR 1.26, p < 0.01) were highly associated with bleeding. Pre-operative demographics associated with increased bleeding risk included older age (OR 1.16-1.31, p < 0.01), male gender (OR 1.10, p < 0.01) and Asian race (OR 1.47, p < 0.01). Staple line reinforcement (OR 0.76, p < 0.01) and oversewing (OR 0.79, p < 0.01) were protective against bleeding after SG. Bleeding was associated with 18 times higher risk of major complications (42.57% vs 2.33%, p < 0.01) and 8 times higher risk of death (1.06% vs 0.13%, p < 0.01).

Conclusions: The risk of bleeding after MBS has decreased over the past 7 years. Patients suffering a bleeding complication have a markedly higher risk of major complications and death. Therefore, identifying methods to reduce post-operative bleeding should be a priority.