title: Pulmonary embolism and gastrointestinal leak following bariatric surgery: when do major complications occur?
abstract: BACKGROUND
  Complications following bariatric surgery are uncommon but potentially life threatening.
  
  
  OBJECTIVE
  The aim of this study was to assess the timing of gastrointestinal leaks (GIL) and pulmonary embolism (PE) in patients undergoing bariatric surgery.
  
  
  METHODS
  Retrospective analysis of the nationwide American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2011.
  
  
  METHODS
  Data on patient demographic characteristics, baseline co-morbidities, procedural events, and postoperative occurrences were analyzed. Thirty-day morbidity was assessed. Median (interquartile range) and frequencies are reported.
  
  
  RESULTS
  We identified 71,694 bariatric surgery patients; median age was 45 years (range 36-54 yr), and median body mass index was 44.8 kg/m(2) (range 40.8-50.3 kg/m(2)). Laparoscopic Roux-en-Y gastric bypass was performed in 39,480 patients, laparoscopic adjustable band in 21,104, laparoscopic sleeve gastrectomy in 3225, open Roux-en-Y gastric bypass in 4243, duodenal switch in 1064, revisional surgery in 1182, and other procedures in 1396 patients. Of these patients, 95.2% had no complications. GIL was found in 441 (.6%), deep vein thrombosis in 184 (.3%), and PE in 134 (.2%). These complications occurred 10 (5-15), 13 (7-20), and 11 (4-19) days after surgery, respectively. GIL and PE developed after discharge in 275 (62.4%) and 96 (71.6%), respectively. Only 35 (26.1%) of the patients who developed PE had deep vein thrombosis. There were no differences in patient characteristics between the groups of early PE versus postdischarge PE. Patients diagnosed with in-hospital GIL were more obese with more severe systemic disease compared with patients with postdischarge diagnosis.
  
  
  CONCLUSIONS
  The majority of GILs and PEs after bariatric surgery occur after discharge. This finding goes against the routine use of contrast studies to rule out GIL. The risk of PE remains after discharge from bariatric surgery.
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina. Electronic address: spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Sippey
authors.affiliation: Department of Surgery, Billings Clinic, Billings, Montana.
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: William H
authors.initials: WH
authors.lastname: Chapman
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology*; D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009009:Montana / Q000453:epidemiology; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015431:Weight Loss
keywords: Bariatric; Complications; Leak; NSQIP; Organ space infection; Pulmonary embolism