The impact of reduced intraoperative mean arterial pressure on postoperative hemorrhage in bariatric surgery

TL;DR

Lower blood pressure during the final stages of bariatric surgery increases the risk of postoperative bleeding.

Contribution

This study identifies intraoperative mean arterial pressure as a risk factor for postoperative hemorrhage in bariatric surgery.

Findings

Patients with postoperative hemorrhage had significantly lower MAP in the last 10 and 30 minutes of surgery.

An intraoperative MAP below 90 mmHg was associated with a higher risk of postoperative hemorrhage.

No significant differences in comorbidities or surgical duration were found between groups.

Abstract

Postoperative hemorrhage (POH) is a life-threatening complication, occurring in 1.3–1.7% of bariatric surgeries and still constitutes a recognized challenge. This study examined the effect of intraoperative mean arterial pressure (MAP) on the development of POH.

A retrospective observational study with a case–control design was conducted on adult patients who underwent bariatric surgery between 2015 and 2023 at a high-volume academic center. Intraoperative MAP (including MAP in the last 10 and 30 min) was collected in patients who developed POH. Cases were matched with controls by sex, gender, type of procedure, and ASA classification.

From 204 participants, 102 patients with POH were matched with 102 controls. The most common procedure performed was Roux-en-Y gastric bypass (n = 98, 48%), followed by sleeve gastrectomy (n = 77, 37.7%). Patients with POH had statistically significant lower intraoperative MAP during the last 10 min (92.41 ± 14.25 vs 97.44 ± 14.64, p = 0.014) and 30 min (87.93 ± 12.32 vs 91.93 ± 11.26, p = 0.016) of surgery compared to controls. An intraoperative MAP lower than 90 mmHg in the last 10 min (OR = 2.067, 95% CI = 1.156–3.695), 30 min (OR = 2.231, 95% CI = 1.27–3.919), and whole procedure (OR = 1.834, 95% CI = 1.024–3.285) was associated with increased risk of POH. No significant differences were found in comorbidities, smoking, preoperative laboratory results, history of antiplatelet therapy or anticoagulation use, and operative time between the two groups.

Our study demonstrates that patients with POH had lower intraoperative MAP during the last 10 and 30 min of surgery. An intraoperative MAP < 90 mmHg was identified as a risk factor for developing POH.