Venous Thromboembolism More Frequent after Open Colorectal Surgery than Post-laparoscopy

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The risk of developing venous thromboembolism (VTE) may be nearly twice as high for patients undergoing open colorectal procedures as for those undergoing laparoscopic colorectal resections, according to a report in the Archives of Surgery. The authors also “identified malignancy, obesity, and congestive heart failure as statistically significant (< .05) risk factors for VTE” in association with open and laparoscopic colorectal surgery.

Researchers from the University of California–Irvine Medical Center, Orange, based their findings on National Inpatient Sample data for 149,304 patients who underwent laparoscopic or open colorectal procedures from 2002 to 2006. Laparoscopic surgeries were performed in 7,848, or 5.3% of the total. While patients undergoing laparoscopic procedures generally had fewer comorbidities than those who underwent open procedures, the most common pathologic condition overall was cancer of any type, with an incidence of 42.4%, the authors reported.

Data Breakdown

Overall, VTE was diagnosed in 2,102 patients (1.4%). The investigators found that the incidence of VTE was significantly lower in the laparoscopic group (65 patients) than in the open procedure group (2,036 patients)—0.8% vs 1.4%; P < .001. By pathologic condition, patients with inflammatory bowel disease had the highest incidence of VTE (1.4%), followed by cancer (1.3%) and diverticulitis (0.9%). By surgical resection site, rectal resection had the greatest incidence of VTE (2.8%), “which may be attributable to the extensive pelvic dissection required with resultant surrounding inflammatory involvement of the pelvic veins,” the authors stated.

Factors associated with an increased risk of VTE were limited to congestive heart failure, obesity, and malignancy in the laparoscopic group, but in the open procedure group also included chronic pulmonary disease, pulmonary circulation disorders, and inflammatory bowel disease. “Our findings, therefore, call into question whether we should be using the same risk factors and stratification for [laparoscopic] procedures as we do for [open] procedures because certain risk factors for VTE in a patient undergoing open colorectal surgery do not seem to portend an increased risk of VTE in the same patient undergoing laparoscopic colorectal surgery,” the authors noted.

“These study findings may be used by surgeons to more accurately assess a patient’s risk for perioperative VTE as well as to select appropriate thromboprophylaxis in patients undergoing laparoscopic colorectal surgery,” they concluded.

Buchberg B, et al: Arch Surg 146:739-743, 2011.




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