In abdominal surgery, procedure-specific risks of venous thromboembolism (VTE) and major bleeding vary widely, with evidence suggesting that the impact of thromboprophylaxis on VTE and bleeding risk depends on the specific procedure.
The following is a summary of “Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery” published in the February 2024 issue of Surgery by Lavikainen, et al.
For a study, researchers sought to give procedure-specific predictions of venous thromboembolism (VTE) symptoms and major bleeds following abdominal surgery. The use of drug thromboprophylaxis comes with risks of VTE and bleeding that vary from procedure to procedure, and their severity is still unknown. Finding observational studies that reported procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery was their first step. They then adjusted the reported estimates for thromboprophylaxis and length of follow-up, estimated the cumulative incidence at 4 weeks post-surgery, stratified by VTE risk groups, and rated the certainty of the evidence.
Of the 285 studies that were screened for suitability, 24 hepatopancreatobiliary surgery procedures, 36 colon surgery procedures, 15 upper gastrointestinal surgery procedures, and 40 general abdominal surgery procedures were found to be qualified. There was moderate to low evidence certainty for VTE and low to very low evidence certainty for bleeding that needed reintervention. The risk of VTE varies a lot depending on the procedure. In general abdominal surgery, the risk ranged from less than 0.1% for laparoscopic cholecystectomy to 3.7% for open small bowel resection. In colorectal surgery, it ranged from 0.3% for minimally invasive sigmoid colectomy to 10.0% for emergency open total proctocolectomy. In upper gastrointestinal/hepatopancreatobiliary surgery, it ranged from 0.2% for laparoscopic sleeve gastrectomy to 6.8% for open distal pancreatectomy for cancer.
In some procedures, like open colectomy and open pancreaticoduodenectomy, VTE thromboprophylaxis reduces VTE and causes a small rise in bleeding. In other procedures, like laparoscopic cholecystectomy and planned groin hernia fixes, it does the opposite. In many processes, the chances of VTE and bleeding are the same, and the choice that is made depends on the person’s risk assessment as well as their values and tastes when it comes to VTE and bleeding.
