C. Quinn3, Z. Leslie2, J. Jenkins1, T. Inturi1, A. Hasan1, S. Ikramuddin1, E. Wise1 1University Of Minnesota, Surgery, Minneapolis, MN, USA 2Carleton College, Northfield, MN, USA 3University Of Minnesota, School Of Medicine, Minneapolis, MN, USA
Introduction:
The National Inpatient Sample (NIS) is a comprehensive United States dataset for inpatient hospitalizations and is designed to be nationally representative; the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is data collected in a standard manner with mandatory reporting by accredited bariatric programs across the nation. To date, there has been no comparison of significant postoperative hemorrhage rates nor a comparison of predictors of hemorrhage between the NIS and MBSAQIP databases. The aim of this study was to compare trends and predictors of significant hemorrhage after bariatric surgery using two national databases
Methods:
The core NIS file of the Healthcare Cost and Utilization Project (HCUP) dataset and the MBSAQIP PUF files from 2016-2021 were concatenated, and vertical sleeve gastrectomy and Roux-en-Y gastric bypass procedures were included after appropriate exclusions (Figure). Trends in postoperative hemorrhage requiring blood transfusion were derived for hospital stays for the NIS and MBSAQIP as well as a 30-day rate, which is only captured by the MBSAQIP. Demographic, comorbidity, and other health factors common to each dataset were identified and analyzed to construct a multivariable logistic regression model for both the NIS and MBSAQIP.
Results:
A total of 204,866 and 1,029,979 patients were identified in the NIS and MBSAQIP, respectively, and three day inpatient hospital blood transfusion rates were 0.47% and 0.63%, respectively. Anticoagulants usage, black race, diabetes, and increased age were each associated with higher risk of a blood transfusion in both databases. VSG had lower blood transfusion risk than RYGB (NIS: OR 0.0.62 [0.54, 0.72], P<0.05, MBSAQIP: OR 0.52 [0.49,0.55], P<0.05). When comparing hospital transfusions, the NIS reported consistently lower 3-day blood transfusion rates in each annual dataset relative to the MBSAQIP. The NIS full in hospital blood transfusion rate was 0.52%; hence, most (92%) significant postoperative hemorrhage requiring transfusion occurs in the first three days after sleeve or bypass operation.
Conclusion:
Healthcare professionals should be aware of the associated risk factors for blood transfusion after bariatric surgery. Most blood transfusions occurred during the initial hospitalization.