Duration and Magnitude of Postoperative Risk of Venous Thromboembolism after Cholecystectomy: A Population-Based Cohort Study

Abstract

Background: This study aimed to identify the burden and risk of venous thromboembolism (VTE) associated with cholecystectomy in England. Methods: An historical cohort study of cholecystectomy patients from 2001 to 2011 was undertaken using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Crude rates and adjusted hazard ratios (HRs) were calculated for risk of VTE following cholecystectomy using Cox regression. Results: 24,677 patients were identified with a rate of VTE in the first year following cholecystectomy of 2.80 per 1,000 person years (95% CI 2.18–3.59). Patients aged ≥70 vs. aged < 50 had 8.3-fold increase in risk of VTE (HR 8.27, 95% CI 3.72–18.35); patients with body mass index (BMI) > 30 vs. BMI < 30 had 2.4-fold increase in risk (HR 2.42, 95% CI 1.40–4.18); open vs. laparoscopic operation had 3-fold increase in risk (HR 2.94, 95% CI 1.55–5.55). Compared to general population, VTE risk was the highest in the first 30 days post-operatively with 9.9-fold risk following emergency cholecystectomy and 4.5-fold risk after inpatient cholecystectomy (HR 9.90, 95% CI 4.42–22.21; HR 4.54, 95% CI 2.85–7.21). Conclusions: Cholecystectomy is associated with a low absolute risk of VTE and we have identified high risk groups including the elderly, obese and those having open surgery.

Pre‐operative and intra‐operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study

“…The rates of symptomatic VTE (0.3%) and post‐operative bleeding (2.4%) in our cohort are comparable to international studies 14–23 . Importantly, our findings reflect those seen in patients who have undergone hip arthroplasty and spinal surgery, 11,12 that when compared with early chemoprophylaxis, its post‐operative use is associated with a lower risk of bleeding without compromising protection against thromboembolism.…”

Time trends in the incidence rates of venous thromboembolism following colorectal resection by indication and operative technique

“…This study utilized three validated and linked healthcare databases that have been described previously [ 34 , 35 , 36 ]. The Clinical Practice Research Datalink (CPRD), comprising the CPRD GOLD and Aurum databases, contains primary care prescription and diagnostic data for approximately 60 million patients of the UK general population, with 16 million actively contributing data [ 37 ].…”

“…This study utilized three validated and linked healthcare databases that have been described previously [34][35][36]…”

Risk of Postoperative Venous Thromboembolism After Benign Colorectal Surgery: Systematic Review and Meta-analysis

“…Fourteen database studies were from the United States, 5,6,[22][23][24][25][26][27][28][29][30][31][32][33] and 1 national cohort study was from the United Kingdom. 34 Eight studies reported that their cohort included patients with IBD, 5,6,23,25,28,29,31,32 2 of which reported either exclusively Crohn's disease (CD) or ulcerative colitis (UC). 29,31 Eight studies identified their cohort as including patients with diverticulitis.…”

“…There were 2 studies reporting on CD, 5,29 3 on UC, 5,31,32 and 5 on diverticulitis 5,6,13,23,34 Thirty-day postoperative VTE incidence risk of volvulus, C difficile colitis, and intestinal ischemia were 1.98% (43/2175), 3.0% (22/733), and 4.37% (133/3041), respectively. The rate per 1000 person-years was 243 (95% CI, 180-328) for volvulus, 371 (95% CI, 244-563) for C difficile colitis, and 544 (95% CI, 459-645) for intestinal ischemia.…”