Liu, David Shi Hao

Newbold, Ryan

Stevens, Sean

Wong, Enoch

Fong, Jonathan

Mori, Krinal

Wong, Darren J

Gill, Anna Sonia

Lee, Sharon

Jamel, Wael

Crowe, Amy

Howard, Tess

Jain, Anshini

Beh, Pith Soh

Slevin, Maeve

Fleming, Nicola

Bennet, Simon

Chung, Chi

2022-03-22

Abdominal visceral resections incur relatively higher rates of postoperative bleeding and venous thromboembolism (VTE). While guidelines recommend the use of perioperative chemical thromboprophylaxis, the most appropriate time for its initiation is unknown. Here, we investigated whether early (before skin closure) versus postoperative commencement of chemoprophylaxis affected VTE and bleeding rates following abdominal visceral resection. Retrospective review of all elective abdominal visceral resections undertaken between January 1, 2018, and June 30, 2019, across four tertiary-referral hospitals. Major bleeding was defined as the need for blood transfusion, reintervention, or > 20 g/L fall in hemoglobin from baseline. Clinical VTE was defined as imaging-proven symptomatic disease < 30 days post-surgery. A total of 945 cases were analyzed. Chemoprophylaxis was given early in 265 (28.0%) patients and postoperatively in 680 (72.0%) patients. Mean chemoprophylaxis exposure doses were similar between the two groups. Clinical VTE developed in 14 (1.5%) patients and was unrelated to chemoprophylaxis timing. Postoperative bleeding occurred in 71 (7.5%) patients, with 57 (80.3%) major bleeds, requiring blood transfusion in 48 (67.6%) cases and reintervention in 31 (43.7%) cases. Bleeding extended length-of-stay (median (IQR), 12 (7-27) versus 7 (5-11) days, p < 0.001). Importantly, compared to postoperative chemoprophylaxis, early administration significantly increased the risk of bleeding (10.6% versus 6.3%, RR 1.45, 95% CI 1.05-1.93, p = 0.038) and independently predicted its occurrence. The risk of bleeding following elective abdominal visceral resections is substantial and is higher than the risk of clinical VTE. Compared with early chemoprophylaxis, postoperative initiation reduces bleeding risk without an increased risk of clinical VTE.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract 2022; 26(7): 1495-1502

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

0000-0001-8936-4123

0000-0003-3522-1412

0000-0001-8513-2130

0000-0003-0117-0071

0000-0002-5366-3049

0000-0002-0037-5238

https://ahro.austin.org.au/austinjspui/handle/1/29613

Chemoprophylaxis

Laparotomy

Thromboembolism

Timing

Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study.

Journal Article