• Lauri I Lavikainen, Gordon H Guyatt, Ville J Sallinen, Paul J Karanicolas, Rachel J Couban, Tino Singh, Yung Lee, Jaana Elberkennou, Riikka Aaltonen, Kaisa Ahopelto, Ines Beilmann-Lehtonen, Marco H Blanker, Jovita L Cárdenas, Rufus Cartwright, Samantha Craigie, P J Devereaux, Herney A Garcia-Perdomo, Fang Zhou Ge, Huda A Gomaa, Alex L E Halme, Jari Haukka, Päivi K Karjalainen, Tuomas P Kilpeläinen, Antti J Kivelä, Hanna Lampela, Anne K Mattila, Borna Tadayon Najafabadi, Taina P Nykänen, Sanjay Pandanaboyana, Negar Pourjamal, Chathura B B Ratnayake, Aleksi Raudasoja, Robin W M Vernooij, Philippe D Violette, Yuting Wang, Yingqi Xiao, Liang Yao, TikkinenKari A OKAOFaculty of Medicine, University of Helsinki, Helsinki, Finland.Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finla, and ROTBIGGS Investigators.
• Faculty of Medicine, University of Helsinki, Helsinki, Finland.
• Ann. Surg. 2024 Feb 1; 279 (2): 213225213-225.

ObjectiveTo provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.BackgroundThe use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.MethodsWe 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.ResultsAfter 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.ConclusionsVTE 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.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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