Bariatric Surgery and the Long-Term Risk of Venous Thromboembolism: A Population-Based Cohort Study

Laura B Harrington; Luke Benz; Sebastien Haneuse; Eric Johnson; Karen J Coleman; Anita P Courcoulas; Robert A Li; Mary Kay Theis; Julie Cooper; Philip L Chin; Gary G Grinberg; Christopher R Daigle; Julietta H Chang; Scott S Um; Panduranga R Yenumula; Jorge Zelada Getty; David E Arterburn

doi:10.1007/s11695-024-07236-y

Bariatric Surgery and the Long-Term Risk of Venous Thromboembolism: A Population-Based Cohort Study

Obes Surg. 2024 Apr 30. doi: 10.1007/s11695-024-07236-y. Online ahead of print.

Authors

Laura B Harrington^{1

2

3}, Luke Benz⁴, Sebastien Haneuse⁴, Eric Johnson⁵, Karen J Coleman⁶, Anita P Courcoulas⁷, Robert A Li⁸, Mary Kay Theis⁵, Julie Cooper⁵, Philip L Chin⁶, Gary G Grinberg⁸, Christopher R Daigle⁵, Julietta H Chang⁵, Scott S Um⁶, Panduranga R Yenumula⁸, Jorge Zelada Getty⁶, David E Arterburn^{5

9}

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Ste. 1600, Seattle, WA, 98101, USA. Laura.B.Harrington@kp.org.
² Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, 98195, USA. Laura.B.Harrington@kp.org.
³ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA. Laura.B.Harrington@kp.org.
⁴ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
⁵ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Ste. 1600, Seattle, WA, 98101, USA.
⁶ Kaiser Permanente Southern California, Pasadena, CA, 91101, USA.
⁷ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
⁸ Kaiser Permanente Northern California, Oakland, CA, 94611, USA.
⁹ Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, 98104, USA.

PMID: 38689074
DOI: 10.1007/s11695-024-07236-y

Abstract

Purpose: Bariatric surgery is associated with a greater venous thromboembolism (VTE) risk in the weeks following surgery, but the long-term risk of VTE is incompletely characterized. We evaluated bariatric surgery in relation to long-term VTE risk.

Materials and methods: This population-based retrospective matched cohort study within three United States-based integrated health care systems included adults with body mass index (BMI) ≥ 35 kg/m² who underwent bariatric surgery between January 2005 and September 2015 (n = 30,171), matched to nonsurgical patients on site, age, sex, BMI, diabetes, insulin use, race/ethnicity, comorbidity score, and health care utilization (n = 218,961). Follow-up for incident VTE ended September 2015 (median 9.3, max 10.7 years).

Results: Our population included 30,171 bariatric surgery patients and 218,961 controls; we identified 4068 VTE events. At 30 days post-index date, bariatric surgery was associated with a fivefold greater VTE risk (HR_adj = 5.01; 95% CI = 4.14, 6.05) and a nearly fourfold greater PE risk (HR_adj = 3.93; 95% CI = 2.87, 5.38) than no bariatric surgery. At 1 year post-index date, bariatric surgery was associated with a 48% lower VTE risk and a 70% lower PE risk (HR_adj = 0.52; 95% CI = 0.41, 0.66 and HR_adj = 0.30; 95% CI = 0.21, 0.44, respectively). At 5 years post-index date, lower VTE risks persisted, with bariatric surgery associated with a 41% lower VTE risk and a 55% lower PE risk (HR_adj = 0.59; 95% CI = 0.48, 0.73 and HR_adj = 0.45; 95% CI = 0.32, 0.64, respectively).

Conclusion: Although in the short-term bariatric surgery is associated with a greater VTE risk, in the long-term, it is associated with a substantially lower risk.

Keywords: Bariatric surgery; Obesity; Venous thromboembolism.

Abstract

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