Significant differences in postoperative venous thromboembolism and bleeding risks

A series of systematic reviews, modeling studies, and meta-analyses – using data from hundreds of original studies and more than 10 million patients – demonstrate that risks vary considerably depending on the type of surgery. The researchers developed a new tool for assessing the risks of surgical complications.

Key findings:

  • The range of risks is enormous. Surgery-specific risks range from under 0.1% (e.g., laparoscopic gallbladder surgery to as much as 10% (e.g., emergency bowel surgery). The risk of major bleeding also varies similarly.
  • Cancer surgery does not automatically mean a high risk. For example, the risk of thromboembolism is over 11% in extensive pelvic cancer surgery (exenteration), but only about 1% in laparoscopic hysterectomy and lymph-node removal.
  • Weighing venous thromboembolism and bleeding risks is central to care. Pharmacological prevention reduces the relative risk of venous thromboembolism, but increases the relative risk of bleeding to a similar extent. This makes baseline risk identification critical in tailoring care.
  • Challenging established knowledge in venous thromboembolism prevention. For example, the risk of thromboembolism associated with laparoscopic sleeve gastrectomy is only 0.3% – the same as the risk of bleeding requiring a reintervention. This questions the currently common practice of routine anticoagulant therapy in these patients.

A new tool for risk assessment

A risk calculator entitled the Clue Post-Surgery VTE Risk Instrument has been developed on the basis of the study, available free of charge online at www.cluevte.org. Designed to be both simple and practical, the tool allows clinicians and patients to make more precise, evidence-based decisions about preventive medication by considering. The tool uses just four inputs, procedure type, patient’s age, body mass index and history of venous thromboembolism.

Improved patient care

The study is a step towards a future in which we can avoid both unnecessary overtreatment and dangerous undertreatment.

“For the patient, this means better care, fewer complications and greater confidence in their treatment being exactly what they need,” says doctoral researcher Lauri Lavikainen.

"For the healthcare system, this means better decision-making, wiser resource use and more sustainable and effective healthcare."

Contact information:
Lauri Lavikainen
Lauri.Lavikainen@helsinki.fi