RT Journal
A1 Trinh Q, Sun M, Sammon J, Karakiewicz PI
T1 Venous thromboembolism in colorectal surgery: How much does laparoscopy impart an advantage?
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD February 1
VO 147
IS 2
SP 199
OP 199
DO 10.1001/archsurg.2011.1488
UL http://dx.doi.org/10.1001/archsurg.2011.1488
AB 
We performed a comparable analysis based on data from the same data set and same years as those of Buchberg et al.1 We relied on propensity-based matching to adjust for the selection bias inherent in observational data2 and on the generalized estimating equation to account for clustering.3 Covariates consisted of patient age, sex, race, year of surgery, insurance status, hospital region, hospital location, hospital teaching status, annual hospital caseload, comorbidities, site of resection, and pathologic condition. Our results showed that open colorectal resections were associated with a 34% higher rate of venous thromboembolism relative to laparoscopic colorectal resections (odds ratio, 1.34 [95% CI, 1.14-1.63]). These findings imply that certain processes of care might be superior at institutions where laparoscopic colorectal resections are more often performed (namely, high-volume urban and/or teaching institutions)4 and that these account for a significant portion of the difference in rates of venous thromboembolism. Regardless, the discrepancy between what the previous authors reported and the current analyses rests in the lack of adjustment for important patient and hospital characteristics. After controlling for these variables, the higher rate of venous thromboembolism associated with open colorectal resections was less pronounced. These considerations are essential to correctly interpret the results, the lack of which may result in misleading conclusions.