Background

Pulmonary embolus (PE) in patients with obesity carries a high mortality. An analysis of the MBSAQIP database was performed to determine predictors of PE in patients undergoing elective bariatric surgery.

Methods

We extracted data from the MBSAQIP database on patients who underwent elective Roux-en-Y gastric bypass or sleeve gastrectomy. Data was extracted on patient co-morbidities, race, prior history of deep vein thrombosis (DVT), and type of DVT prophylaxis. A multivariate logistic regression model was developed to determine predictors of PE.

Results

Prior history of DVT (OR: 3.28; 95% CI: 1.85-5.83; p < 0.0001), African American Race (OR: 3.03; 95% CI: 2.22 - 4.13; p < 0.0001), gastroesophageal reflux disease (GERD) (OR: 1.51; 95% CI: 1.11 - 2.04; p = 0.008) higher BMI (OR: 1.11; 95% CI: 1.01 - 1.20; p = 0.023), male sex (OR: 1.76; 95% CI: 1.26 - 2.45; p = 0.001), and older age (OR: 1.27; 95% CI: 1.10 - 1.46; p = 0.001) were associated with increased odds of PE. COPD, sleep apnea, hypertension were all not significant predictors of PE (p > 0.05). Neither combined mechanical and pharmacological DVT prophylaxis, nor pharmacological prophylaxis alone were significant predictors of PE (p > 0.05).

Conclusions

Prior history of DVT is the strongest predictor of PE after bariatric surgery. African American Race, male sex, and GERD are additional risk factors in this patient population. Preoperative identification of these high-risk patients may prevent delays in the diagnosis of PEs.