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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

Lookup NU author(s): Sanjay PandanaboyanaORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2024 Lippincott Williams and Wilkins. All rights reserved.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.

Publication metadata

Author(s): Lavikainen LI, Guyatt GH, Sallinen VJ, Karanicolas PJ, Couban RJ, Singh T, Lee Y, Elberkennou J, Aaltonen R, Ahopelto K, Beilmann-Lehtonen I, Blanker MH, Cardenas JL, Cartwright R, Craigie S, Devereaux PJ, Garcia-Perdomo HA, Ge FZ, Gomaa HA, Halme ALE, Haukka J, Karjalainen PK, Kilpelainen TP, Kivela AJ, Lampela H, Mattila AK, Najafabadi BT, Nykanen TP, Pandanaboyana S, Pourjamal N, Ratnayake CBB, Raudasoja A, Vernooij RWM, Violette PD, Wang Y, Xiao Y, Yao L, Tikkinen KAO

Publication type: Article

Publication status: Published

Journal: Annals of Surgery

Year: 2024

Volume: 279

Issue: 2

Pages: 213-225

Print publication date: 01/02/2024

Online publication date: 08/08/2023

Acceptance date: 24/07/2023

Date deposited: 19/04/2024

ISSN (print): 0003-4932

ISSN (electronic): 1528-1140

Publisher: Wolters Kluwer Health


DOI: 10.1097/SLA.0000000000006059

PubMed id: 37551583


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Funder referenceFunder name
Academy of Finland
Helsinki University Hospital
Finnish Medical Foundation
Sigrid Jusélius Foundation