Minimally Invasive Colorectal Surgery Cuts VTE Risk
Patients undergoing laparoscopic colorectal surgery had fewer clotting complications than were seen with open procedures, researchers found. Venous thromboembolism (VTE) occurred in 1.44% of patients who had open surgery but in only 0.83% of those having a colorectal resection laparoscopically (P<0.001), Michael J. Stamos, MD, of the University of California Irvine Medical Center, and colleagues reported in the June issue of Archives of Surgery. Other VTE risk factors among colorectal surgery patients in the national administrative database study included inflammatory bowel disease, cancer, obesity, and congestive heart failure. Action Points
- Explain that patients undergoing laparoscopic colorectal surgery had a lower rate of venous thromboembolism than was seen with open procedures.
- Note that laparoscopic surgery was also associated with shorter hospital stays and lower mortality rates compared with the open resection.
“These findings may guide surgeons in the selection of appropriate VTE prophylaxis for patients undergoing colorectal procedures,” Stamos and colleagues wrote.
Whether that might mean differences in dosing or other aspects of prophylaxis isn’t clear yet, although laparoscopic surgery doesn’t eliminate the need for prophylaxis, noted co-author Ninh Nguyen, MD, also of UC Irvine.
But the results do give impetus to greater use of laparoscopy in colorectal surgery, following the trend in other types of surgery which have also shown reduced VTE with laparoscopic approaches, Nguyen suggested.
“VTE is one factor for mortality associated with colorectal surgery,” he told MedPage Today in an interview. “Anything you can do to reduce the incidence should be utilized.”
Colorectal surgery patients are at a particularly elevated risk of serious clotting, with a pulmonary embolism risk about four times that of other surgery patients in one prior study.
A laparoscopic approach may help by getting patients back on their feet earlier through reduced postoperative pain and ileus compared with open surgery, the researchers suggested.
Laparoscopic surgery may also induce less hypercoagulability compared with open surgery, Nguyen noted.
The group analyzed the Nationwide Inpatient Sample database, with discharge data from about 20% of U.S. community hospitals for a representative picture of about 90% of all hospital discharges across the country.
During the 60-month period from 2002 through 2006, the database included 149,304 patients who got laparoscopic or open colorectal resection — most often for cancer (42.4%) and involving the right colon (42.5%).
Among the resections overall, only 5.3% were done with laparoscopic techniques.
But even in the multivariate analysis, laparoscopic colorectal surgery held the advantage for VTE incidence. Patients were 1.8 times more likely to experience this complication after open resection (OR 1.8, 95% CI 1.4 to 2.2).
For each precipitating condition, laparoscopic surgery was also associated with at least numerically lower VTE risk.
Inflammatory bowel disease showed the highest incidence of VTE among the pathologies at 1.4% as well as the most dramatic, albeit nonsignificant, difference in incidence by surgical approach at 1.47% with open versus 0.33% with laparoscopic surgery.
Cancer patients, with a VTE incidence of 1.3% overall, showed only a minimal and nonsignificant advantage from laparoscopic resection (1.18% versus 1.27% VTE rate with open surgery).
For diverticulitis, the advantage of laparoscopic surgery reached statistical significance with a VTE incidence rate of 0.47% compared with open surgery’s 0.88% (P<0.05).
Other risk factors for VTE in the multivariate analysis included the following:
- Obesity in both the laparoscopic and open surgery groups (OR 2.3, 95% CI 1.4 to 2.2, and OR 1.9, 95% CI 1.7 to 2.1)
- Congestive heart failure in both laparoscopic and open surgery groups (OR 2.o, 95% CI 1.3 to 3.2, and OR 1.1, 95% CI 1.1 to 1.2)
- Malignancy in the laparoscopic group (OR 1.5, 95% CI 1.1 to 2.1) and metastatic cancer in the open surgery group (OR 1.9, 95% CI 1.8 to 2.0)
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Chronic pulmonary disease (OR 1.1, 95% CI 1.1 to 1.2) and pulmonary circulation disorders (OR 1.5, 95% CI 1.2 to 2.0) in the open surgery group
Compared with open colorectal surgery, laparoscopic surgery was also associated with shorter hospital stays (6.5 versus 9.5 days, P<0.001) and lower mortality rates (0.8% versus 3.0%, P<0.001).
The researchers cautioned that their study was limited by the use of administrative data, which may have missed some laparoscopic surgeries and wouldn’t catch any VTE after hospital discharge or the influence of thromboprophylaxis.
Another limitation was the possibility of residual confounding from the open colorectal surgery group including higher-risk patients with more comorbidities.
“Although we controlled for these risk factors, they may have predisposed the patient to VTE from the outset and possibly contributed to prolonged immobilization of the patient,” Stamos’ group cautioned in the paper.
The researchers reported having no conflicts of interest to disclose.
Minimally Invasive Colorectal Surgery Cuts VTE Risk
Tags: Colorectal, mortality rates, california irvine medical, pulmonary disease
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