Pulmonary Embolism and Deep Venous Thrombosis Following Laparoscopic Cholecystectomy

Abstract

There is considerable uncertainty related to the thromboembolic risk after laparoscopic cholecystectomy. Patients with pulmonary embolism (PE), deep venous thrombosis (DVT), or venous thromboembolism (VTE) at hospital discharge following laparoscopic cholecystectomy were identified from the Nationwide Inpatient Sample. From 1998 through 2009, 4 107 430 laparoscopic cholecystectomies were performed. The in-hospital prevalence of PE was 0.15%, DVT was 0.40%, and VTE was 0.53%. The prevalence of PE increased from 0.04% in patients aged 21 to 30 years to 0.31% in patients aged 71 to 80 years. Deaths due to in-hospital PE were 780 (0.02%) of the 4 107 430 laparoscopic cholecystectomies. The rate of death increased with age. The prevalence of VTE following laparoscopic cholecystectomy is low and fatal PE is rare. The risk of VTE increased with age, as did the risk of death in those who had PE. These data may be useful in assessing the use of thromboprophylaxis in patients undergoing laparoscopic cholecystectomy.

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.…”

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

“…Indeed, Stein et al reported the prevalence of VTE after laparoscopic cholecystectomy increased from 0.17% in patients aged 21 to 30 years to 0.90% in patients aged 71 to 80 years, similar to our findings [28]. White et al reported a steady increase in the incidence of VTE with increasing age in cholecystectomy [8].…”

Does thromboprophylaxis cause bleeding after laparoscopic cholecystectomy?

“…It is now widely accepted that surgical patients in moderate to high risk of VTE must be given some sort of thromboprophylaxis (3). For laparoscopic cholecystectomy, however, there has been considerable debate on the severity of risk of thromboembolism and hence the necessity of thromboprophylaxis for this surgi-cal procedure (4)(5)(6)(7)(8). Although there is an advantage of laparoscopic cholecystectomy over an open procedure due to reduced surgical trauma; the pneumoperitoneum and reverse Trendelenburg position during the procedure may theoretically lead to venous stasis in legs (5), which may be speculated to increase the risk for thromboembolic complications.…”

“…Although there is an advantage of laparoscopic cholecystectomy over an open procedure due to reduced surgical trauma; the pneumoperitoneum and reverse Trendelenburg position during the procedure may theoretically lead to venous stasis in legs (5), which may be speculated to increase the risk for thromboembolic complications. On the other hand, a meta-analysis of 153,832 patients (9) and recent large scale clinical studies revealed rather low rates of complications related to venous thromboembolism after laparoscopic cholecystectomy (4,10). One of these studies reported an increased risk of bleeding complications in patients receiving thromboprophylaxis, further questioning the routine use of antithrombotic medication in patients undergoing laparoscopic cholecystectomy (10).…”