The incidence of venous thromboembolism after colorectal surgery: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Chao ^1,2 ,  HAN Jinsong ²

1. Graduate School, Jinzhou Medical University, Jinzhou, Liaoning 121001, P. R. China;
2. Department of Cardiovascular Surgery, General Hospital of North Theater Command, Shenyang 110016, P. R. China;

Corresponding author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

venous thromboembolism; colorectal surgery; incidence; meta-analysis

DOI：

10.7507/1007-9424.201907048

Video：

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Objective To comprehensively evaluate the incidence of venous thromboembolism (VTE) after colorectal surgery.Methods We searched PubMed/Medline, Web of science, and Embase databases by computer, collected studies by using the combination of corresponding English keywords. Then, we screened literatures according to inclusion and exclusion criteria, and evaluated the quality of literatures by using Downs and Black tools. Finally, we used Stata 15.1 and R Project 3.4.1 for meta-analysis.Results A total of 15 studies (n=721 730) were included in the meta-analysis. The combined incidence of VTE after colorectal surgery was 2.26% [95% CI was (1.93%, 2.61%), P<0.000 1], and the incidence of VTE after adjusting for publication bias was 1.82% [95% CI was (1.53%, 2.13%), P<0.000 1]. Meta regression analysis revealed that patients’ age (P<0.000 1), smoking (P=0.000 4), open surgery (P=0.020 0), preoperative albumin level (P=0.023 6), and malignant tumor (P=0.036 4) were correlated with the incidence of VTE after colorectal surgery, which may be potential factors for heterogeneity.Conclusions The incidence of VTE after colorectal surgery is not insignificant. It is necessary for clinicians to be vigilant about the occurrence of VTE after colorectal surgery and provide appropriate preventive interventions in combination with patients’ own risk factors, disease-related factors, and surgical factors.

Citation： MA Chao, HAN Jinsong. The incidence of venous thromboembolism after colorectal surgery: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 182-191. doi: 10.7507/1007-9424.201907048 Copy

1.	Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
2.	Alcalay A, Wun T, Khatri V, et al. Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol, 2006, 24(7): 1112-1118.
3.	Devani K, Patil N, Simons-Linares CR, et al. Trends in hospitalization and mortality of venous thromboembolism in hospitalized patients with colon cancer and their outcomes: US perspective. Clin Colorectal Cancer, 2017, 16(3): e199-e204.
4.	Metcalf RL, Al-Hadithi E, Hopley N, et al. Characterisation and risk assessment of venous thromboembolism in gastrointestinal cancers. World J Gastrointest Oncol, 2017, 9(9): 363-371.
5.	Bergqvist D. Venous thromboembolism: a review of risk and prevention in colorectal surgery patients. Dis Colon Rectum, 2006, 49(10): 1620-1628.
6.	Fleming FJ, Kim MJ, Salloum RM, et al. How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum, 2010, 53(10): 1355-1360.
7.	Alizadeh RF, Sujatha-Bhaskar S, Li S, et al. Venous throm-boembolism in common laparoscopic abdominal surgical operations. Am J Surg, 2017, 214(6): 1127-1132.
8.	Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
9.	Barendregt JJ, Doi SA, Lee YY, et al. Meta-analysis of prevalence. J Epidemiol Community Health, 2013, 67(11): 974-978.
10.	Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
11.	Shapiro R, Vogel JD, Kiran RP. Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum, 2011, 54(12): 1496-1502.
12.	Xenos ES, Vargas HD, Davenport DL. Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res, 2012, 129(5): 568-572.
13.	Buchberg B, Masoomi H, Lusby K, et al. Incidence and risk factors of venous thromboembolism in colorectal surgery: does laparoscopy impart an advantage? Arch Surg, 2011, 146(6): 739-743.
14.	Kwon S, Meissner M, Symons R, et al. Perioperative pharmacologic prophylaxis for venous thromboembolism in colorectal surgery. J Am Coll Surg, 2011, 213(5): 596-603, 603.e1.
15.	Henke PK, Arya S, Pannucci C, et al. Procedure-specific venous thromboembolism prophylaxis: a paradigm from colectomy surgery. Surgery, 2012, 152(4): 528-536.
16.	Wallaert JB, De Martino RR, Marsicovetere PS, et al. Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP. Dis Colon Rectum, 2012, 55(11): 1138-1144.
17.	Davenport DL, Vargas HD, Kasten MW, et al. Timing and perioperative risk factors for in-hospital and post-discharge venous thromboembolism after colorectal cancer resection. Clin Appl Thromb Hemost, 2012, 18(6): 569-575.
18.	Walker AJ, West J, Card TR, et al. Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England. J Thromb Haemost, 2014, 12(5): 641-649.
19.	Colorectal Writing Group for Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative, Nelson DW, Simianu VV, et al. Thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA Surg, 2015, 150(8): 712-720.
20.	El-Dhuwaib Y, Selvasekar C, Corless DJ, et al. Venous thromboembolism following colorectal resection. Colorectal Dis, 2017, 19(4): 385-394.
21.	Moghadamyeghaneh Z, Alizadeh RF, Hanna MH, et al. Post-hospital discharge venous thromboembolism in colorectal surgery. World J Surg, 2016, 40(5): 1255-1263.
22.	Lee E, Kang SB, Choi SI, et al. Prospective study on the incidence of postoperative venous thromboembolism in Korean patients with colorectal cancer. Cancer Res Treat, 2016, 48(3): 978-989.
23.	Beal EW, Tumin D, Chakedis J, et al. Which patients require extended thromboprophylaxis after colectomy? Modeling risk and assessing indications for post-discharge pharmacoprophylaxis. World J Surg, 2018, 42(7): 2242-2251.
24.	Wang KL, Yap ES, Goto S, et al. The diagnosis and treatment of venous thromboembolism in Asian patients. Thromb J, 2018, 16: 4.
25.	Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost, 2005, 3(8): 1611-1617.
26.	McNally MP, Burns CJ. Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg, 2009, 22(1): 34-40.
27.	Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol, 2015, 12(8): 464-474.
28.	Lee LH. Clinical update on deep vein thrombosis in Singapore. Ann Acad Med Singapore, 2002, 31(2): 248-252.
29.	Kim DS, Park KM, Won YS, et al. Occurrence and prognosis of symptomatic venous thromboembolism in colorectal cancer surgery patients. Vasc Specialist Int, 2014, 30(2): 49-55.
30.	Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med, 2000, 160(6): 809-815.
31.	Iversen LH, Thorlacius-Ussing O. Relationship of coagulation test abnormalities to tumour burden and postoperative DVT in resected colorectal cancer. Thromb Haemost, 2002, 87(3): 402-408.
32.	Stender MT, Nielsen TS, Frøkjaer JB, et al. High preoperative prevalence of deep venous thrombosis in patients with colorectal cancer. Br J Surg, 2007, 94(9): 1100-1103.
33.	Bernstein CN, Blanchard JF, Houston DS, et al. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost, 2001, 85(3): 430-434.
34.	Solem CA, Loftus EV, Tremaine WJ, et al. Venous thromboembolism in inflammatory bowel disease. Am J Gastroenterol, 2004, 99(1): 97-101.
35.	Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 3-14.
36.	White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost, 2003, 90(3): 446-455.
37.	Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(25 Suppl 2): S49-S73.
38.	Mahmoodi BK, Cushman M, Anne Næss I, et al. Association of traditional cardiovascular risk factors with venous thromboembolism: an individual participant data meta-analysis of prospective studies. Circulation, 2017, 135(1): 7-16.
39.	Cui G, Wang X, Yao W, et al. Incidence of postoperative venous thromboembolism after laparoscopic versus open colorectal cancer surgery: a meta-analysis. Surg Laparosc Endosc Percutan Tech, 2013, 23(2): 128-134.
40.	Iannuzzi JC, Aquina CT, Rickles AS, et al. Risk factors for postdischarge venothromboembolism after colorectal resection. Dis Colon Rectum, 2016, 59(3): 224-229.
41.	Agnelli G, Bolis G, Capussotti L, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg, 2006, 243(1): 89-95.
42.	Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013, 31(17): 2189-2204.
43.	Paar M, Rossmann C, Nusshold C, et al. Anticoagulant action of low, physiologic, and high albumin levels in whole blood. PLoS One, 2017, 12(8): e0182997.
44.	Rasmussen KC, Højskov M, Johansson PI, et al. Impact of albumin on coagulation competence and hemorrhage during major surgery: a randomized controlled trial. Medicine (Baltimore), 2016, 95(9): e2720.

1. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e227S-e277S.
2. Alcalay A, Wun T, Khatri V, et al. Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol, 2006, 24(7): 1112-1118.
3. Devani K, Patil N, Simons-Linares CR, et al. Trends in hospitalization and mortality of venous thromboembolism in hospitalized patients with colon cancer and their outcomes: US perspective. Clin Colorectal Cancer, 2017, 16(3): e199-e204.
4. Metcalf RL, Al-Hadithi E, Hopley N, et al. Characterisation and risk assessment of venous thromboembolism in gastrointestinal cancers. World J Gastrointest Oncol, 2017, 9(9): 363-371.
5. Bergqvist D. Venous thromboembolism: a review of risk and prevention in colorectal surgery patients. Dis Colon Rectum, 2006, 49(10): 1620-1628.
6. Fleming FJ, Kim MJ, Salloum RM, et al. How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum, 2010, 53(10): 1355-1360.
7. Alizadeh RF, Sujatha-Bhaskar S, Li S, et al. Venous throm-boembolism in common laparoscopic abdominal surgical operations. Am J Surg, 2017, 214(6): 1127-1132.
8. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health, 1998, 52(6): 377-384.
9. Barendregt JJ, Doi SA, Lee YY, et al. Meta-analysis of prevalence. J Epidemiol Community Health, 2013, 67(11): 974-978.
10. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
11. Shapiro R, Vogel JD, Kiran RP. Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum, 2011, 54(12): 1496-1502.
12. Xenos ES, Vargas HD, Davenport DL. Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res, 2012, 129(5): 568-572.
13. Buchberg B, Masoomi H, Lusby K, et al. Incidence and risk factors of venous thromboembolism in colorectal surgery: does laparoscopy impart an advantage? Arch Surg, 2011, 146(6): 739-743.
14. Kwon S, Meissner M, Symons R, et al. Perioperative pharmacologic prophylaxis for venous thromboembolism in colorectal surgery. J Am Coll Surg, 2011, 213(5): 596-603, 603.e1.
15. Henke PK, Arya S, Pannucci C, et al. Procedure-specific venous thromboembolism prophylaxis: a paradigm from colectomy surgery. Surgery, 2012, 152(4): 528-536.
16. Wallaert JB, De Martino RR, Marsicovetere PS, et al. Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP. Dis Colon Rectum, 2012, 55(11): 1138-1144.
17. Davenport DL, Vargas HD, Kasten MW, et al. Timing and perioperative risk factors for in-hospital and post-discharge venous thromboembolism after colorectal cancer resection. Clin Appl Thromb Hemost, 2012, 18(6): 569-575.
18. Walker AJ, West J, Card TR, et al. Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England. J Thromb Haemost, 2014, 12(5): 641-649.
19. Colorectal Writing Group for Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative, Nelson DW, Simianu VV, et al. Thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA Surg, 2015, 150(8): 712-720.
20. El-Dhuwaib Y, Selvasekar C, Corless DJ, et al. Venous thromboembolism following colorectal resection. Colorectal Dis, 2017, 19(4): 385-394.
21. Moghadamyeghaneh Z, Alizadeh RF, Hanna MH, et al. Post-hospital discharge venous thromboembolism in colorectal surgery. World J Surg, 2016, 40(5): 1255-1263.
22. Lee E, Kang SB, Choi SI, et al. Prospective study on the incidence of postoperative venous thromboembolism in Korean patients with colorectal cancer. Cancer Res Treat, 2016, 48(3): 978-989.
23. Beal EW, Tumin D, Chakedis J, et al. Which patients require extended thromboprophylaxis after colectomy? Modeling risk and assessing indications for post-discharge pharmacoprophylaxis. World J Surg, 2018, 42(7): 2242-2251.
24. Wang KL, Yap ES, Goto S, et al. The diagnosis and treatment of venous thromboembolism in Asian patients. Thromb J, 2018, 16: 4.
25. Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost, 2005, 3(8): 1611-1617.
26. McNally MP, Burns CJ. Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg, 2009, 22(1): 34-40.
27. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol, 2015, 12(8): 464-474.
28. Lee LH. Clinical update on deep vein thrombosis in Singapore. Ann Acad Med Singapore, 2002, 31(2): 248-252.
29. Kim DS, Park KM, Won YS, et al. Occurrence and prognosis of symptomatic venous thromboembolism in colorectal cancer surgery patients. Vasc Specialist Int, 2014, 30(2): 49-55.
30. Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med, 2000, 160(6): 809-815.
31. Iversen LH, Thorlacius-Ussing O. Relationship of coagulation test abnormalities to tumour burden and postoperative DVT in resected colorectal cancer. Thromb Haemost, 2002, 87(3): 402-408.
32. Stender MT, Nielsen TS, Frøkjaer JB, et al. High preoperative prevalence of deep venous thrombosis in patients with colorectal cancer. Br J Surg, 2007, 94(9): 1100-1103.
33. Bernstein CN, Blanchard JF, Houston DS, et al. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost, 2001, 85(3): 430-434.
34. Solem CA, Loftus EV, Tremaine WJ, et al. Venous thromboembolism in inflammatory bowel disease. Am J Gastroenterol, 2004, 99(1): 97-101.
35. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 3-14.
36. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost, 2003, 90(3): 446-455.
37. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(25 Suppl 2): S49-S73.
38. Mahmoodi BK, Cushman M, Anne Næss I, et al. Association of traditional cardiovascular risk factors with venous thromboembolism: an individual participant data meta-analysis of prospective studies. Circulation, 2017, 135(1): 7-16.
39. Cui G, Wang X, Yao W, et al. Incidence of postoperative venous thromboembolism after laparoscopic versus open colorectal cancer surgery: a meta-analysis. Surg Laparosc Endosc Percutan Tech, 2013, 23(2): 128-134.
40. Iannuzzi JC, Aquina CT, Rickles AS, et al. Risk factors for postdischarge venothromboembolism after colorectal resection. Dis Colon Rectum, 2016, 59(3): 224-229.
41. Agnelli G, Bolis G, Capussotti L, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg, 2006, 243(1): 89-95.
42. Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2013, 31(17): 2189-2204.
43. Paar M, Rossmann C, Nusshold C, et al. Anticoagulant action of low, physiologic, and high albumin levels in whole blood. PLoS One, 2017, 12(8): e0182997.
44. Rasmussen KC, Højskov M, Johansson PI, et al. Impact of albumin on coagulation competence and hemorrhage during major surgery: a randomized controlled trial. Medicine (Baltimore), 2016, 95(9): e2720.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The incidence of venous thromboembolism after colorectal surgery: a meta-analysis

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