Status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery based on national clinical database (NCD) data in Japan

Taishi Hata; Hiroyuki Yamamoto; Masataka Ikeda; Hiroaki Nagano; Ichiro Takemasa; Takeshi Naitoh; Norikazu Yamada; Mamoru Uemura; Hidetoshi Eguchi; Yoshihiro Kakeji; Ken Shirabe; Yuichiro Doki

doi:10.1007/s00595-024-02969-w

Status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery based on national clinical database (NCD) data in Japan

Surg Today. 2024 Dec 4. doi: 10.1007/s00595-024-02969-w. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan. hata-taishi@kansaih.johas.go.jp.
² Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan.
⁴ Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
⁵ Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan.
⁶ Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
⁷ Department of Cardiology, Kuwana City Medical Center, Mie, Japan.
⁸ Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
⁹ Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
¹⁰ The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.

PMID: 39630284
DOI: 10.1007/s00595-024-02969-w

Abstract

Purpose: To investigate the current status of perioperative venous thromboembolism (VTE) prophylaxis in gastrointestinal surgery in Japan.

Methods: We reviewed data on eight gastroenterological procedures from the Japanese National Clinical Database (NCD), accrued between 2018 and 2020. Patient characteristics, prophylactic methods, postoperative bleeding, cardiac arrest, and postoperative mortality rate within 30 days were retrieved.

Results: Despite recommendations, approximately 30% of patients did not receive VTE prophylaxis, suggesting a lack of awareness. Pharmacological prophylaxis was associated with a higher incidence of VTE than mechanical or no prophylaxis for all procedures. Combined prophylaxis resulted in a lower incidence of VTE than pharmacological prophylaxis alone. Pharmacological prophylaxis was also associated with an increased incidence of bleeding events. The risk of cardiac arrest and death was higher in patients with pulmonary embolism (PE), but there was a trend toward lower mortality in the group that received pharmacological prophylaxis.

Conclusion: Pharmacological prophylaxis for VTE was limited in reducing the incidence of VTE, but it may reduce the risk of death. Combining pharmacological and mechanical prophylaxis tended to be more effective for preventing VTE than either method alone. Conversely, pharmacological prophylaxis may increase the risk of bleeding.

Keywords: Gastrointestinal surgery; National clinical database; Postoperative outcomes; Prophylaxis; Venous thromboembolism.