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Meta-Analysis
. 2024 Feb 1;279(2):213-225.
doi: 10.1097/SLA.0000000000006059. Epub 2023 Aug 8.

Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery

Lauri I Lavikainen  1 , Gordon H Guyatt  2   3 , Ville J Sallinen  4   5 , Paul J Karanicolas  6   7 , Rachel J Couban  8 , Tino Singh  9 , Yung Lee  10 , Jaana Elberkennou  11 , Riikka Aaltonen  12 , Kaisa Ahopelto  4 , Ines Beilmann-Lehtonen  4 , Marco H Blanker  13 , Jovita L Cárdenas  14 , Rufus Cartwright  15 , Samantha Craigie  2 , P J Devereaux  2   3   16   17 , Herney A Garcia-Perdomo  18 , Fang Zhou Ge  19 , Huda A Gomaa  20   21 , Alex L E Halme  1 , Jari Haukka  22   23 , Päivi K Karjalainen  24 , Tuomas P Kilpeläinen  25 , Antti J Kivelä  5 , Hanna Lampela  5 , Anne K Mattila  26 , Borna Tadayon Najafabadi  2 , Taina P Nykänen  27 , Sanjay Pandanaboyana  28   29 , Negar Pourjamal  1 , Chathura B B Ratnayake  30   31 , Aleksi Raudasoja  1 , Robin W M Vernooij  32   33 , Philippe D Violette  2   34 , Yuting Wang  2 , Yingqi Xiao  2   35 , Liang Yao  2 , Kari A O Tikkinen  1   25   36 ; ROTBIGGS Investigators
Collaborators, Affiliations
Meta-Analysis

Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery

Lauri I Lavikainen et al. Ann Surg. .

Abstract

Objective: To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.

Background: The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.

Methods: We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty.

Results: After eligibility screening, 285 studies (8,048,635 patients) reporting on 40 general abdominal, 36 colorectal, 15 upper gastrointestinal, and 24 hepatopancreatobiliary surgery procedures proved eligible. Evidence certainty proved generally moderate or low for VTE and low or very low for bleeding requiring reintervention. The risk of VTE varied substantially among procedures: in general abdominal surgery from a median of <0.1% in laparoscopic cholecystectomy to a median of 3.7% in open small bowel resection, in colorectal from 0.3% in minimally invasive sigmoid colectomy to 10.0% in emergency open total proctocolectomy, and in upper gastrointestinal/hepatopancreatobiliary from 0.2% in laparoscopic sleeve gastrectomy to 6.8% in open distal pancreatectomy for cancer.

Conclusions: VTE thromboprophylaxis provides net benefit through VTE reduction with a small increase in bleeding in some procedures (eg, open colectomy and open pancreaticoduodenectomy), whereas the opposite is true in others (eg, laparoscopic cholecystectomy and elective groin hernia repairs). In many procedures, thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding.

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Conflict of interest statement

P.J.K. received a research grant from the Focused Ultrasound Foundation (all unrelated to this manuscript). P.J.D. received research grants from Abbott Laboratories, CloudDX, Philips Healthcare, Roche Diagnostics, and Siemens (all unrelated to this manuscript). R.C., P.D.V., and K.A.O.T. are panel members of the European Society of Anesthesiology and Intensive Care (ESAIC) Task Force for the European Guidelines on Venous Thromboembolism (VTE). The remaining authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Infographic providing procedure-specific risk estimates of symptomatic VTE and bleeding requiring reintervention after general abdominal surgery procedures.
FIGURE 2
FIGURE 2
Infographic providing procedure-specific risk estimates of symptomatic VTE and bleeding requiring reintervention after colorectal surgery procedures.
FIGURE 3
FIGURE 3
Infographic providing procedure-specific risk estimates of symptomatic VTE and bleeding requiring reintervention after upper gastrointestinal and hepatopancreatobiliary surgery procedures.
See this image and copyright information in PMC

Comment in

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