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Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery.
Lavikainen, Lauri I; Guyatt, Gordon H; Sallinen, Ville J; Karanicolas, Paul J; Couban, Rachel J; Singh, Tino; Lee, Yung; Elberkennou, Jaana; Aaltonen, Riikka; Ahopelto, Kaisa; Beilmann-Lehtonen, Ines; Blanker, Marco H; Cárdenas, Jovita L; Cartwright, Rufus; Craigie, Samantha; Devereaux, P J; Garcia-Perdomo, Herney A; Ge, Fang Zhou; Gomaa, Huda A; Halme, Alex L E; Haukka, Jari; Karjalainen, Päivi K; Kilpeläinen, Tuomas P; Kivelä, Antti J; Lampela, Hanna; Mattila, Anne K; Najafabadi, Borna Tadayon; Nykänen, Taina P; Pandanaboyana, Sanjay; Pourjamal, Negar; Ratnayake, Chathura B B; Raudasoja, Aleksi; Vernooij, Robin W M; Violette, Philippe D; Wang, Yuting; Xiao, Yingqi; Yao, Liang; Tikkinen, Kari A O.
Affiliation
  • Lavikainen LI; Faculty of Medicine, University of Helsinki, Helsinki, Finland.
  • Guyatt GH; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Sallinen VJ; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Karanicolas PJ; Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Couban RJ; Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Singh T; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Lee Y; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Elberkennou J; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
  • Aaltonen R; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
  • Ahopelto K; Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
  • Beilmann-Lehtonen I; Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.
  • Blanker MH; Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
  • Cárdenas JL; Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Cartwright R; Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Craigie S; Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  • Devereaux PJ; Direction of Health Technologies Assessment, National Center for Health Technology Excellence (CENETEC), Mexico City, Mexico.
  • Garcia-Perdomo HA; Departments of Gynecology and Gender Affirmation Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK.
  • Ge FZ; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Gomaa HA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Halme ALE; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Haukka J; Anesthesiology, Perioperative Medicine, and Surgical Research Group, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
  • Karjalainen PK; Department of Outcomes Research, Outcomes Research Consortium, Cleveland, OH, USA.
  • Kilpeläinen TP; Department of Surgery, Division of Urology, School of Medicine, Universidad del Valle, Cali, Colombia.
  • Kivelä AJ; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
  • Lampela H; Department of Biostatistics, High Institute of Public Health, Alexandria University, Egypt.
  • Mattila AK; Department of Medical Pharmacology, Tanta Chest Hospital, Ministry of Health and Population, Tanta, Egypt.
  • Najafabadi BT; Faculty of Medicine, University of Helsinki, Helsinki, Finland.
  • Nykänen TP; Health Sciences, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
  • Pandanaboyana S; Clinicum/Department of Public Health, University of Helsinki, Helsinki, Finland.
  • Pourjamal N; Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland.
  • Ratnayake CBB; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Raudasoja A; Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Vernooij RWM; Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Violette PD; Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
  • Wang Y; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • Xiao Y; Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland.
  • Yao L; Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
  • Tikkinen KAO; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
Ann Surg ; 279(2): 213-225, 2024 Feb 01.
Article in En | MEDLINE | ID: mdl-37551583
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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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Thrombosis / Colorectal Neoplasms / Venous Thromboembolism Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Surg Year: 2024 Document type: Article Affiliation country: Finland Country of publication: United States
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Thrombosis / Colorectal Neoplasms / Venous Thromboembolism Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Surg Year: 2024 Document type: Article Affiliation country: Finland Country of publication: United States