title: Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach?
abstract: BACKGROUND
  Venous thromboembolism constitutes a major cause of morbidity associated with surgical procedures. Colorectal surgical patients are at an elevated risk for postoperative venous thromboembolism. Whether the laparoscopic approach influences this risk is not well defined.
  
  
  OBJECTIVE
  This study aimed to assess the risk of venous thromboembolism following major colorectal procedures. The influences of laparoscopic and open approaches on venous thromboembolism were compared while controlling for other potential confounders.
  
  
  METHODS
  Patients who underwent major colorectal procedures were identified. Association between patient, disease, operation-related factors, and venous thromboembolism within 30 days of surgery was determined by the use of a logistic regression analysis.
  
  
  METHODS
  Patients were identified from the National Surgical Quality Improvement Program database (2005-2008).
  
  
  METHODS
  According to the National Surgical Quality Improvement Program database, 31,109 patients underwent colorectal surgery (open, 71%; laparoscopic, 29%) for cancer (48.3%), IBD (10.1%), diverticular disease (24.2%), and other benign conditions (17.4%).
  
  
  METHODS
  The primary outcomes measured were deep venous thrombosis and pulmonary embolism.
  
  
  RESULTS
  The venous thromboembolism rate was 2.4% (laparoscopic 1.2% vs open 2.9%, P < .001). Patients who developed venous thromboembolism were older (age 65.4 vs 61.5, P < .001), more often male (52.5% vs 47.5%, P = .023), with worse functional status (P < .001), and more comorbidities (P < .001). Venous thromboembolism was associated with sepsis (7.9% vs 1.8%, P < .001), steroid use (5.4% vs 2.2%, P < .001), surgical site infection (4.8% vs 2%, P < .001), and reoperation (7% vs 2.1%, P < .001). On multivariate analysis, open surgery, older age, steroid use, sepsis, surgical site infection, reoperation, prolonged ventilation, and low albumin were independently associated with a higher venous thromboembolism rate.
  
  
  CONCLUSIONS
  The details regarding determinants of the decision for laparoscopic surgery, conversion rates for laparoscopic procedures, and thrombosis prophylaxis regimens were not available.
  
  
  CONCLUSIONS
  The laparoscopic approach is associated with a lower venous thromboembolism rate in comparison with open surgery, despite controlling for other variables. This additional benefit of the minimally invasive approach further supports its use, whenever feasible, for a variety of colorectal conditions.
authors: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44122, USA.
authors: Ron
authors: R
authors: Shapiro
authors: Jon D
authors: JD
authors: Vogel
authors: Ravi P
authors: RP
authors: Kiran
mesh_terms: D000367:Age Factors; D000368:Aged; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology*