Factors Associated with Postoperative Hemorrhage in Primary Metabolic Bariatric Surgery: Nationwide Analysis of Patient Characteristics, Surgical and Stapling Techniques
8 affiliations
- 1Dutch Institute for Clinical Auditing, Leiden, Netherlands
- 2Department of Surgery, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- 3Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
- 4Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands
- 5Department of Surgery, Ziekenhuis Gelderse Vallei, Ede, Netherlands
- 6Department of Surgery, Catharina Ziekenhuis, Eindhoven, Netherlands
- 7Department of Surgery, Groene Hart Ziekenhuis, Gouda, Netherlands
- 8Nederlandse Obesitas Kliniek, Den Haag en Gouda, Netherlands
Abstract
Introduction: Postoperative hemorrhage is the most common severe complication following metabolic bariatric surgery (MBS). Evidence on associations with surgical and stapling techniques, tranexamic acid (TXA) use, and thromboprophylaxis regimens remains scarce. The aim of this study is to evaluate patient characteristics, surgical and stapling techniques, thromboprophylaxis regimens, and TXA use as factors associated with postoperative hemorrhage following primary MBS.
Methods: Patients undergoing primary MBS between 2015 and 2024 were selected from the Dutch Audit for Treatment of Obesity (DATO). Surgical details, including surgical and stapling techniques, stapler brand, thromboprophylaxis regimens, and TXA protocols, were retrospectively collected via nationwide questionnaires. The primary outcome was postoperative hemorrhage (Clavien Dindo (CD) grade ≥ 2) within 30 days of the procedure. Secondary outcomes included reinterventions, intensive care unit admission, mortality, and length of hospital stay. Multilevel logistic regression analysis was performed to identify factors associated with postoperative hemorrhage of CD grade ≥ 2.
Results: A total of 83,580 patients were included, with 18,701 sleeve gastrectomies (SG) and 64,879 bypass procedures. Postoperative hemorrhage of CD grade ≥ 2 occurred in 1.2% (n = 1021). The following factors were independently associated with postoperative hemorrhage: BMI (kg/m2) (adjusted odds ratio [aOR] = 0.974; 95% confidence interval [CI]: 0.957–0.991), stroke or transient ischemic attack in medical history (aOR = 1.751; 95% CI: 1.097–2.796), hypertension (aOR = 1.341; 95% CI: 1.080–1.665), and liver disease (aOR = 1.838; 95% CI: 1.038–3.253).
Conclusion: Despite limitations inherent in its retrospective, questionnaire-based design, the findings indicate that patient-related factors are associated with postoperative hemorrhage risk in MBS.
Key points: • Postoperative hemorrhage is the most common severe short term complication following MBS.
• Most postoperative hemorrhages require surgical reintervention.
• There is no association between surgical techniques and postoperative hemorrhage.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11695-026-08930-9.
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BibTeX
@article{brouwer2026factors,
title = {{Factors Associated with Postoperative Hemorrhage in Primary Metabolic Bariatric Surgery: Nationwide Analysis of Patient Characteristics, Surgical and Stapling Techniques}},
author = {Anne J. Brouwer and Mabel M.A. Kwakkelstein and Jan A. Apers and Floris F.E. Bruinsma and Martin Dunkelgrün and Bo J. Noordman and Guusje Vugts and Simon W. Nienhuijs and Ronald S.L. Liem and Dutch Audit for Treatment of Obesity Research Group},
journal = {Obesity Surgery},
year = {2026},
month = oct,
doi = {10.1007/s11695-026-08930-9},
url = {https://doi.org/10.1007/s11695-026-08930-9},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors Associated with Postoperative Hemorrhage in Primary Metabolic Bariatric Surgery: Nationwide Analysis of Patient Characteristics, Surgical and Stapling Techniques
AU - Anne J. Brouwer
AU - Mabel M.A. Kwakkelstein
AU - Jan A. Apers
AU - Floris F.E. Bruinsma
AU - Martin Dunkelgrün
AU - Bo J. Noordman
AU - Guusje Vugts
AU - Simon W. Nienhuijs
AU - Ronald S.L. Liem
AU - Dutch Audit for Treatment of Obesity Research Group
PY - 2026
DA - 2026/10/02
JO - Obesity Surgery
DO - 10.1007/s11695-026-08930-9
UR - https://doi.org/10.1007/s11695-026-08930-9
AB - Introduction: Postoperative hemorrhage is the most common severe complication following metabolic bariatric surgery (MBS). Evidence on associations with surgical and stapling techniques, tranexamic acid (TXA) use, and thromboprophylaxis regimens remains scarce. The aim of this study is to evaluate patient characteristics, surgical and stapling techniques, thromboprophylaxis regimens, and TXA use as factors associated with postoperative hemorrhage following primary MBS. Methods: Patients undergoing primary MBS between 2015 and 2024 were selected from the Dutch Audit for Treatment of Obesity (DATO). Surgical details, including surgical and stapling techniques, stapler brand, thromboprophylaxis regimens, and TXA protocols, were retrospectively collected via nationwide questionnaires. The primary outcome was postoperative hemorrhage (Clavien Dindo (CD) grade ≥ 2) within 30 days of the procedure. Secondary outcomes included reinterventions, intensive care unit admission, mortality, and length of hospital stay. Multilevel logistic regression analysis was performed to identify factors associated with postoperative hemorrhage of CD grade ≥ 2. Results: A total of 83,580 patients were included, with 18,701 sleeve gastrectomies (SG) and 64,879 bypass procedures. Postoperative hemorrhage of CD grade ≥ 2 occurred in 1.2% (n = 1021). The following factors were independently associated with postoperative hemorrhage: BMI (kg/m2) (adjusted odds ratio [aOR] = 0.974; 95% confidence interval [CI]: 0.957–0.991), stroke or transient ischemic attack in medical history (aOR = 1.751; 95% CI: 1.097–2.796), hypertension (aOR = 1.341; 95% CI: 1.080–1.665), and liver disease (aOR = 1.838; 95% CI: 1.038–3.253). Conclusion: Despite limitations inherent in its retrospective, questionnaire-based design, the findings indicate that patient-related factors are associated with postoperative hemorrhage risk in MBS. Key points: • Postoperative hemorrhage is the most common severe short term complication following MBS. • Most postoperative hemorrhages require surgical reintervention. • There is no association between surgical techniques and postoperative hemorrhage. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11695-026-08930-9.
SN - 0960-8923
SN - 1708-0428
ER -