Post-Operative Bleeding in the Bariatric Population – The Role of Serial Hemoglobin Labs

Abstract There are several initiatives to target different facets of peri-operative care maximize the value of the care we provide. There is one area of our peri-operative care where protocol driven recommendations are lacking– post-operative laboratory tests. Some institutional studies have shown that post-operative day one laboratory tests are rarely abnormal and rarely intervened on. Currently, our enhanced bariatric surgery recovery protocol at TriHealth has a very strong focus on post-operative VTE prophylaxis. This includes multiple hemoglobin laboratory tests in the first few post-operative days to guide our VTE prophylaxis regimen and possibly identify patients with post-operative bleeding. The purpose of this study was to investigate the necessity of serial hemoglobin laboratory tests in our post-operative bariatric population and help identify significant patient symptoms that can guide clinicians to pursue further laboratory investigation. We conducted a retrospective cohort study evaluating all patients who underwent primary and revisional bariatric surgery at TriHealth facilities from January 2016 to December 2021. We categorized patients into two groups for analysis: patients who received a blood transfusion and patients who did not receive a blood transfusion but had a significant hemoglobin drop over 3g/dL. We found that there is a strongly significant difference in the symptoms of anemia in patients who eventually require transfusion compared to patients who do not require transfusion with a significant post-operative hemoglobin drop. Our research suggests that bariatric patients with post-operative bleeding requiring transfusion will “declare” themselves with significantly higher heart rates and with significant symptoms of anemia.