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Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy

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Abstract

Background

The benefit of thromboembolism prophylaxis in cholecystectomy is controversial. This population-based study report on the incidence of and risk factors for symptomatic venous thromboembolism (VTE) after cholecystectomy.

Method

All cholecystectomies registered in the Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) between 2006 and 2011 were reviewed. By linking patient data to the Swedish National Patient Register (NPR), the 30-day postoperative incidence of VTE (deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) was identified. Age- and gender-standardized incidence ratio (SIR) for deep venous thrombosis (DVT) and pulmonary embolism (PE) were calculated. Multivariable analysis determined risk factors for VTE by calculating odds ratio (OR).

Results

Altogether 62,488 procedures were registered and postoperative VTE was seen in 154 (0.25 %) patients. DVT was seen in 36 (0.06 %) patients and PE in 25 (0.04 %) patients within 30 days after surgery. The SIR for DVT was 22.2 (95 % confidence interval (CI) 13.1–31.3) and for PE 5.6 (95 % CI 2.3–8.9). Risk factors for VTE within 30 days after cholecystectomy were age >70 years (odds ratio [OR] = 2.69; 95 % confidence interval [CI] 1.68–4.30), open cholecystectomy (OR = 1.95; CI 1.31–2.92), operation time >120 min (OR = 1.66; CI 1.18–2.35), acute cholecystitis (OR = 1.69; CI 1.18–2.42), and previous history of VTE (OR = 50.5; CI 27.3–92.8). Thromboembolism prophylaxis (TP) increased the risk for postoperative bleeding (OR = 1.72; 1.44–2.05).

Conclusion

The incidence of VTE after cholecystectomy is low and thromboembolism prophylaxis (TP) increases the risk for postoperative bleeding. Patients with previous VTE events should be given TP when undergoing cholecystectomy.

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Abbreviations

ACCP:

American College of Chest Physicians

BMI:

Body mass index

CI:

Confidence interval

DVT:

Deep venous thrombosis

ERCP:

Endoscopic retrograde cholangiopancreatography

GallRiks:

Swedish Register for Gallstone Surgery and ERCP

ICD:

International Classification of Disease

LC:

Laparoscopic cholecystectomy

LMWH:

Low molecular weight heparin

NPR:

Swedish National Patient Register

NBHW:

National Board of Health and Welfare

OC:

Open cholecystectomy

OR:

Odds ratio

PE:

Pulmonary embolism

PPV:

Positive predictive value

SIR:

Standardized incidence ratio

TP:

Thromboembolism prophylaxis

VTE:

Venous thromboembolism

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Acknowledgments

This study was made possible by a research grant from the Olle Engkvist Research Foundation.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    J. Strömberg, F. Hammarqvist & G. Sandblom

  2. Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    O. Sadr-Azodi

  3. Department of Surgery, Västmanland County Hospital, Västerås, Sweden

    P. Videhult

  4. Department of Surgery, Kalmar County Hospital, 39185, Kalmar, Sweden

    J. Strömberg

Authors
  1. J. Strömberg
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  2. O. Sadr-Azodi
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  3. P. Videhult
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  4. F. Hammarqvist
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  5. G. Sandblom
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Corresponding author

Correspondence to J. Strömberg.

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Strömberg, J., Sadr-Azodi, O., Videhult, P. et al. Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy. Langenbecks Arch Surg 400, 463–469 (2015). https://doi.org/10.1007/s00423-015-1284-0

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  • DOI: https://doi.org/10.1007/s00423-015-1284-0

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