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Lookup NU author(s): Sanjay PandanaboyanaORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 Lippincott Williams and Wilkins. All rights reserved.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.
Author(s): Lavikainen LI, Guyatt GH, Sallinen VJ, Karanicolas PJ, Couban RJ, Singh T, Lee Y, Elberkennou J, Aaltonen R, Ahopelto K, Beilmann-Lehtonen I, Blanker MH, Cardenas JL, Cartwright R, Craigie S, Devereaux PJ, Garcia-Perdomo HA, Ge FZ, Gomaa HA, Halme ALE, Haukka J, Karjalainen PK, Kilpelainen TP, Kivela AJ, Lampela H, Mattila AK, Najafabadi BT, Nykanen TP, Pandanaboyana S, Pourjamal N, Ratnayake CBB, Raudasoja A, Vernooij RWM, Violette PD, Wang Y, Xiao Y, Yao L, Tikkinen KAO
Publication type: Article
Publication status: Published
Journal: Annals of Surgery
Year: 2024
Volume: 279
Issue: 2
Pages: 213-225
Print publication date: 01/02/2024
Online publication date: 08/08/2023
Acceptance date: 24/07/2023
Date deposited: 19/04/2024
ISSN (print): 0003-4932
ISSN (electronic): 1528-1140
Publisher: Wolters Kluwer Health
URL: https://doi.org/10.1097/SLA.0000000000006059
DOI: 10.1097/SLA.0000000000006059
PubMed id: 37551583
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