Optimizing the management of obese patients after bariatric interventions to prevent thromboembolic complications

Abstract

Aim: To optimize the management of obese patients in the perioperative period to prevent thromboembolic complications. Materials and Methods: From 2011 to 2024, a total of 988 patients with obesity underwent laparoscopic bariatric surgery at the clinical base of the Department of General Surgery No. 2 of Bogomolets National Medical University. The retrospective group included 498 patients who received treatment between 2011 and 2020. 490 patients were enrolled in the prospective group for the period from 2020 to 2024. Results: Retospective group had 1 episodes of postoperative thromboembolic complication, representing a rate of 0,2%, prospective group – 0 episodes of postoperative bleeding, representing a rate of 0% The stepwise inclusion/exclusion of variables (Stepwise) method was used to select the minimum set of factor characteristics associated with the occurrence of bleeding in patients with MO after laparoscopic gastric bypass. Conclusoins: Shortening the thromboembolic complications prophylaxis regimen from 14 to 7 days in combination with the use of elements of the ERAS protocol did not cause an increase in the level of venous thromboembolism in the prospective group – 0/490 (0%) compared to the retrospective group – 1/498 (0.2%). Intraoperative pneumocompression of the lower extremities as a method of thromboembolic complications prophylaxis is effective in combination with the use of LMWH for a short period (7 days). The use of tranexamic acid preparations together with low molecular weight heparins does not affect the level of thromboembolic complications.