Adverse Outcomes in Patients on Chronic Anticoagulation Therapy Undergoing Sleeve Gastrectomy Conversions: Analysis of 30,664 Patients from the MBSAQIP Database

Introduction: The impact of chronic anticoagulation therapy (CAT) on sleeve gastrectomy (SG) conversions remains unclear. This study compared outcomes between patients with and without CAT undergoing SG conversions using the MBSAQIP database. Methods: A retrospective analysis of the MBSAQIP database (2020–2022) included patients undergoing conversion from SG to Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), or biliopancreatic diversion with duodenal switch (BPD-DS). Primary outcomes were 30-day serious complications. Secondary outcomes included specific complications, length of stay, and operative time. Multivariable logistic regression assessed whether CAT independently predicted outcomes. Results: Of 30,664 patients, 935 (3.05%) were on CAT. CAT patients were older (52.08 vs 45.73 years), had higher BMI (42.34 vs 40.33 kg/m²), and higher rates of diabetes (24.71% vs 11.55%) and hypertension (82.21% vs71.32%) (all p<0.001). Primary conversion indications were reflux disease(51.45%), weight recurrence (26.40%) and insufficient weight loss (14.86%).CAT patients had higher rates of serious complications (14.12% vs 6.42%),readmission (13.80% vs 6.88%), reoperation (4.92% vs 2.77%), and bleeding(4.81% vs 1.68%), with longer operative times (158.63 vs 144.01 minutes)and hospital stays (2.27 vs 1.68 days) (all p<0.001). On multivariable analysis, CAT was not independently associated with serious complications(OR 1.06, 95%CI 0.61-1.85, p=0.824). Conclusion: Patients on CAT undergoing SG conversions experience higher complication rates and longer hospital stays; However, anticoagulation therapy is not independently associated with increased serious complication safter adjusting for obesity-related conditions, highlighting the importance of comprehensive risk assessment and optimization of underlying medical conditions in all high-risk patients undergoing conversion bariatric surgery.