Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Jul 1;66(7):877-885.
doi: 10.1097/DCR.0000000000002915. Epub 2023 Apr 24.

Risk of Postoperative Venous Thromboembolism After Benign Colorectal Surgery: Systematic Review and Meta-analysis

Tjun Wei Leow  1 , Adil Rashid  1 , Christopher A Lewis-Lloyd  1 , Colin J Crooks  2 , David J Humes  1
Affiliations
Meta-Analysis

Risk of Postoperative Venous Thromboembolism After Benign Colorectal Surgery: Systematic Review and Meta-analysis

Tjun Wei Leow et al. Dis Colon Rectum. .

Abstract

Background: Venous thromboembolism is a well-established preventable complication after colectomy. Specific guidance on venous thromboembolism prevention after colectomy for benign disease is limited.

Objective: This meta-analysis aimed to quantify the venous thromboembolism risk after benign colorectal resection and determine its variability.

Data sources: Following Preferred Reporting Items for Systematic Review and Meta-Analysis and Meta-analysis of Observational Studies in Epidemiology Guidelines (PROSPERO: CRD42021265438), Embase, MEDLINE, and 4 other registered medical literature databases were searched from the database inception to June 21, 2021.

Study selection: Inclusion criteria: randomized controlled trials and large population-based database cohort studies reporting 30-day and 90-day venous thromboembolism rates after benign colorectal resection in patients aged ≥18 years. Exclusion criteria: patients undergoing colorectal cancer or completely endoscopic surgery.

Main outcome measures: Thirty- and 90-day venous thromboembolism incidence rates per 1000 person-years after benign colorectal surgery.

Results: Seventeen studies were eligible for meta-analysis reporting on 250,170 patients. Pooled 30-day and 90-day venous thromboembolism incidence rates after benign colorectal resection were 284 (95% CI, 224-360) and 84 (95% CI, 33-218) per 1000 person-years. Stratified by admission type, 30-day venous thromboembolism incidence rates per 1000 person-years were 532 (95% CI, 447-664) for emergency resections and 213 (95% CI, 100-453) for elective colorectal resections. Thirty-day venous thromboembolism incidence rates per 1000 person-years after colectomy were 485 (95% CI, 411-573) for patients with ulcerative colitis, 228 (95% CI, 181-288) for patients with Crohn's disease, and 208 (95% CI, 152-288) for patients with diverticulitis.

Limitations: High degree of heterogeneity was observed within most meta-analyses attributable to large cohorts minimizing within-study variance.

Conclusions: Venous thromboembolism rates remain high up to 90 days after colectomy and vary by indication for surgery. Emergency resections compared to elective benign resections have higher rates of postoperative venous thromboembolism. Further studies reporting venous thromboembolism rates by type of benign disease need to stratify rates by admission type to more accurately define venous thromboembolism risk after colectomy.

Registration no: CRD42021265438.

PubMed Disclaimer

Comment in

References

    1. McDermott KW, Liang L. Overview of Operating Room Procedures During Inpatient Stays in U.S. Hospitals, 2018: Statistical Brief #281 Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US), 2006.
    1. Shapiro R, Vogel JD, Kiran RP. Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum. 2011;54:1496–1502.
    1. McLeod RS, Geerts WH, Sniderman KW, et al.; Canadian Colorectal Surgery DVT Prophylaxis Trial investigators. Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg. 2001;233:438–444.
    1. Huber O, Bounameaux H, Borst F, Rohner A. Postoperative pulmonary embolism after hospital discharge. An underestimated risk. Arch Surg. 1992;127:310–313.
    1. Ali F, Al-Kindi SG, Blank JJ, Peterson CY, Ludwig KA, Ridolfi TJ. Elevated venous thromboembolism risk following colectomy for IBD is equal to those for colorectal cancer for ninety days after surgery. Dis Colon Rectum. 2018;61:375–381.