Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Ann Surg. 2024 Feb 1;279(2):213-225. doi: 10.1097/SLA.0000000000006059. Epub 2023 Aug 8.
To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.
The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.
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.
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.
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.
提供腹部手术后症状性静脉血栓栓塞症（VTE）和大出血的特定手术风险估计。
使用药物性血栓预防代表了一种权衡，取决于 VTE 和出血风险在不同手术之间的变化；其程度仍不确定。
我们确定了报告腹部手术后症状性 VTE 或大出血特定手术风险的观察性研究，调整了报告的预防血栓和随访时间的估计值，并根据 VTE 风险组分层，估计了术后 4 周的累积发生率，并对证据确定性进行了评级。
经过资格筛选，285 项研究（8048635 名患者）符合条件，报告了 40 项普通腹部手术、36 项结直肠手术、15 项上消化道手术和 24 项肝胆胰手术。VTE 和需要再次干预的出血的证据确定性通常为中度或低度，低或非常低。手术之间的 VTE 风险差异很大：普通腹部手术中，从腹腔镜胆囊切除术的中位数<0.1%到开放性小肠切除术的中位数 3.7%，结直肠手术中，从微创乙状结肠切除术的中位数 0.3%到紧急开放性全直肠结肠切除术的中位数 10.0%，上消化道/肝胆胰手术中，从腹腔镜袖状胃切除术的中位数 0.2%到开放性胰头十二指肠切除术的中位数 6.8%。
VTE 预防血栓治疗通过减少 VTE 带来净获益，同时在某些手术中增加少量出血（例如开放性结肠切除术和开放性胰十二指肠切除术），而在其他手术中则相反（例如腹腔镜胆囊切除术和择期腹股沟疝修补术）。在许多手术中，血栓栓塞和出血风险相似，决策取决于个体风险预测以及对 VTE 和出血的价值和偏好。
