Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery-Reference-Cited by-同舟云学术

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

Published:2023-08-08 Issue:2 Volume:279 Page:213-225
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Lavikainen Lauri I.¹,Guyatt Gordon H.²³,Sallinen Ville J.⁴⁵,Karanicolas Paul J.⁶⁷,Couban Rachel J.⁸,Singh Tino⁹,Lee Yung¹⁰,Elberkennou Jaana¹¹,Aaltonen Riikka¹²,Ahopelto Kaisa⁴,Beilmann-Lehtonen Ines⁴,Blanker Marco H.¹³,Cárdenas Jovita L.¹⁴,Cartwright Rufus¹⁵,Craigie Samantha²,Devereaux P.J.²³¹⁶¹⁷,Garcia-Perdomo Herney A.¹⁸,Ge Fang Zhou¹⁹,Gomaa Huda A.²⁰²¹,Halme Alex L.E.¹,Haukka Jari²²²³,Karjalainen Päivi K.²⁴,Kilpeläinen Tuomas P.²⁵,Kivelä Antti J.⁵,Lampela Hanna⁵,Mattila Anne K.²⁶,Najafabadi Borna Tadayon²,Nykänen Taina P.²⁷,Pandanaboyana Sanjay²⁸²⁹,Pourjamal Negar¹,Ratnayake Chathura B.B.³⁰³¹,Raudasoja Aleksi¹,Vernooij Robin W.M.³²³³,Violette Philippe D.²³⁴,Wang Yuting²,Xiao Yingqi²³⁵,Yao Liang²,Tikkinen Kari A. O.¹²⁵³⁶,

Affiliation:

1. Faculty of Medicine, University of Helsinki, Helsinki, Finland

2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

3. Department of Medicine, McMaster University, Hamilton, ON, Canada

4. Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

5. Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

6. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

7. Department of Surgery, University of Toronto, Toronto, ON, Canada

8. Department of Anesthesia, McMaster University, Hamilton, ON, Canada

9. Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

10. Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada

11. Department of Surgery, Vaasa Central Hospital, Vaasa, Finland

12. Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland

13. Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

14. Direction of Health Technologies Assessment, National Center for Health Technology Excellence (CENETEC), Mexico City, Mexico

15. Departments of Gynecology and Gender Affirmation Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK

16. Anesthesiology, Perioperative Medicine, and Surgical Research Group, Population Health Research Institute, McMaster University, Hamilton, ON, Canada

17. Department of Outcomes Research, Outcomes Research Consortium, Cleveland, OH, USA

18. Department of Surgery, Division of Urology, School of Medicine, Universidad del Valle, Cali, Colombia

19. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada

20. Department of Biostatistics, High Institute of Public Health, Alexandria University, Egypt

21. Department of Medical Pharmacology, Tanta Chest Hospital, Ministry of Health and Population, Tanta, Egypt

22. Health Sciences, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

23. Clinicum/Department of Public Health, University of Helsinki, Helsinki, Finland

24. Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland

25. Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

26. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland

27. Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland

28. Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK

29. Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK

30. Department of Surgery, The University of Auckland, Auckland, New Zealand

31. Department of Surgery, Auckland City Hospital, Auckland, New Zealand

32. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

33. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

34. Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada

35. Department of Nursing and West China School of Nursing, West China Hospital and Sichuan University, Chengdu, China

36. Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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