Background

Early postoperative bleeding is an uncommon complication after Roux-en-Y gastric bypass, and is often self-limited, but can cause significant morbidity when uncontrolled hemorrhage occurs. Factors correlating with severe hemorrhage versus self-limited bleeding are unknown.

Methods

A retrospective review was performed using prospectively collected data for all patients undergoing Roux-en-Y gastric bypass surgery over 5.5 years at our institution. Patients were grouped based on post-operative bleeding: no bleeding (<2 g/dL hemoglobin drop), self-limited (> 2 g/dL hemoglobin drop, without transfusion or intervention), and hemorrhage (requiring transfusion or intervention). The 'self-limited' and 'hemorrhage' groups were compared. Categorical data were analyzed using Fisher's exact test or Chi-square. Demographics, comorbidities, and perioperative outcomes were examined.

Results

Of 430 patients, 360 (83.7%) had no bleeding, 43 (10%) had self-limited bleeding, and 27 (6.3%) had hemorrhage. Hemorrhage patients were more likely to have preoperative liver disease compared to 'self-limited' bleeding patients 18.5% vs. 2.3% (p=0.029). Following surgery, hemorrhage patients had more frequent ileus 11.1% vs. 0% (p=0.026), extended LOS 40.7% vs. 18.6% (p=0.043), postop ED visits 44.4% vs. 14.0% (p=0.004), readmissions 44.4% vs. 4.6% (p <.0001), and cardiac 22.2% vs. 2.3% (p=0.011), renal 14.8% vs. 0% (p=0.019), and respiratory complications 33.3% vs. 4.6% (p=0.002).

Conclusions

Uncontrolled bleeding after Roux-en-Y gastric bypass leads to significantly worse outcomes compared to patients who have a self-limited hemoglobin decrease. Patients with preoperative liver disease are at higher risk of post-operative hemorrhage; other factors influencing the development of hemorrhage vs. self-limited bleeding remain unclear.