NEW YORK (Reuters Health) – Venous thromboembolism (VTE) after colorectal surgery is nearly twice as common when a patient undergoes an open procedure compared to laparoscopy, a study using a large, national database shows.
Patients treated laparoscopically also had different risk factors for VTE compared to those who underwent open surgery, Dr. Brian Buchberg and colleagues from the University of California-Irvine Medical Center in Orange report in the June issue of the Archives of Surgery.
“Our findings, therefore, call into question whether we should be using the same risk factors and stratification for LC [laparoscopic colorectal] procedures as we do for OC [open colorectal] procedures because certain risk factors for VTE in a patient undergoing OC surgery do not seem to portend an increased risk of VTE in the same patient undergoing LC surgery,” they write.
Colorectal surgery in general carries a high risk for thromboembolic complications, the researchers note. While aspects of laparoscopic surgery might be expected to lead to a greater risk of such complications, they add, minimally invasive versions of several common gastrointestinal surgeries carry a lower VTE risk than open surgery.
To compare VTE incidence and risk factors in OC versus LC surgeries, the researchers looked at data from the Nationwide Inpatient Sample on 149,304 patients who underwent elective colorectal surgery between 2002 and 2006. About 5 percent of the procedures were performed laparoscopically.
During the index hospitalization, 65 of the 7,848 patients who underwent LC surgery developed VTE (0.8 percent), versus 2,036 of the 141,456 patients treated with open surgery (1.4 percent).
Based on pathologic condition, patients with inflammatory bowel disease (IBD) were at the highest risk of VTE, with 1.4 percent developing the complication overall. The surgical site associated with the greatest risk of VTE was proctectomy, at 2.8 percent.
Multivariate regression analysis found that patients who underwent OC surgery were 1.8 times as likely to develop VTE than patients who had LC surgery. Factors linked to greater VTE risk in the laparoscopic group included obesity (odds ratio, 2.3), congestive heart failure (OR, 2.0), and malignancy (OR, 1.5).
VTE risk factors for open surgery patients included congestive heart failure (OR, 1.1), chronic pulmonary disease (OR, 1.1), obesity (OR, 1.9), metastatic cancer (OR, 1.9), pulmonary circulation disorders (OR, 1.5) and IBD (OR, 1.5).
Patients may be less likely to develop VTE after laparoscopic surgery because they are able to ambulate earlier after the procedure, the authors suggest.
They conclude: “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 LC surgery.”
Arch. Surg. 2011
