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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

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机构: [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]Division of General Surgery, Department of 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]National Center for Health Technology Excellence (CENETEC), Direction of Health Technologies Assessment, Mexico City, Mexico [15]Departments of Gynaecology and Gender Affirmation Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK [16]Population Health Research Institute, McMaster University, Hamilton, ON, Canada [17]Outcomes Research Consortium, Cleveland, OH, USA [18]Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia [19]Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada [20]High Institute of Public Health, Alexandria University, Egypt [21]Tanta Chest Hospital, Ministry of Health and Population, Tanta, Egypt [22]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, Newcastle University, Newcastle Upon Tyne, UK [30]Department of Surgery, The University of Auckland, Auckland, New Zealand [31]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]Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada. [35]West China School of Nursing and Department of Nursing, West China Hospital and Sichuan University, Chengdu, China [36]Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
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关键词: Anterior resection Appendectomy Bariatric Surgery Baseline risk Bleeding Cholecystectomy Colectomy Colorectal surgery Gastrectomy General surgery GRADE Approach Hepatopancreatobiliary Surgery Hernia repair Modeling Proctocolectomy Rectopexy Reporting Risk of bias Small bowel resection Splenectomy Surgery Thromboprophylaxis Upper Gastrointestinal Tract Venous thromboembolism

摘要:
To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding following abdominal surgery.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 post-surgery, 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 between 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 small increase in bleeding in some procedures (e.g., open colectomy, open pancreaticoduodenectomy), whereas the opposite is true in others (e.g., laparoscopic cholecystectomy, 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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大类 | 1 区 医学
小类 | 1 区 外科
最新[2023]版:
大类 | 1 区 医学
小类 | 1 区 外科
第一作者:
第一作者机构: [1]Faculty of Medicine, University of Helsinki, Helsinki, Finland [*1]Faculty of Medicine, University of Helsinki, Helsinki, Finland, Biomedicum 2 B, PL 13, Tukholmankatu 8 B, 00290 Helsinki, Finland
通讯作者:
通讯机构: [1]Faculty of Medicine, University of Helsinki, Helsinki, Finland [25]Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland [36]Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland [*1]Faculty of Medicine, University of Helsinki, Helsinki, Finland, Biomedicum 2 B, PL 13, Tukholmankatu 8 B, 00290 Helsinki, Finland [*2]Department of Urology, University of Helsinki and Helsinki University Hospital, Biomedicum 2 B, PL 13, Tukholmankatu 8 B, 00290 Helsinki, Finland.
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