Patient Suffers Cardiac Arrest After Bariatric Surgery

This case takes place in Georgia and involves a middle-aged female who had a past medical history of obesity, diabetes, hypertension, and coronary artery disease. As a result of her weight and the multiple comorbidities present the patient was identified as a candidate for bariatric surgery. The patient eventually underwent a laparoscopic procedure with no immediately evident complications, and was transferred to the PACU to recover. While in the recovery area, it was noted that the patient’s heart rate was faster than average, while her blood pressure was below normal levels. Despite these findings, the attending physicians did not immediately request a cardiology consultation. Eventually, a cardiologist was called in to examine the patient. The cardiologist suspected internal bleeding, and the patient was scheduled to return to the operating room. Before a corrective operation could be performed, however, the patient suffered cardiac arrest and expired after multiple attempts were made to revive her. It was noted that the patient had been on Xarelto, a blood thinner, at the time of the surgery.

Question(s) For Expert Witness

1. Do you routinely perform these procedures? Please explain.

2. Have you ever published/lectured on this subject ?

3. Have you ever had a patient develop the outcome noted above?

4. When should this patient have been returned to OR?

8. Have you ever reviewed a similar case as an expert witness?

Expert Witness Response E-006188

I think there are a few problems, the least of which is the relatively brief delay getting back to surgery. That delay would not have been considered excessively long had the patient not had an M.I. and cardiac arrest upon returning to surgery; the cardiac arrest is really the source of the morbidity in this case. It seemed like the surgery team was slow in figuring out that the woman needed to go back to the OR for bleeding, but had the patient not had that arrest incident, she probably would have been fine. She did arrest, though. The issues that I think are very significant are 1. The timing of surgery. This woman went for her sleeve within 6 weeks of PCI for unstable angina? That is a considerable deviation from the standard of care. That surgery should have been put off until the Plavix could be stopped without having the stent go down--at least 6 months, perhaps a year. Did cardiology clear her? The surgeon should not have taken a patient for elective sleeve if the Plavix could not be stopped. I would say that is very questionable, especially if the Plavix cannot be stopped because of a recent stent. If there is bleeding, it needs to be stopped. The stent will go down. The clearance and surgery early after PCI are the issue. The delay to surgery is a less significant factor. Additionally, it is unfortunate that the stent went down.