Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 483–490 | Cite as

Incidence and risk of venous thromboembolism in patients following appendectomy: a nationwide cohort study

  • Wei-Sheng ChungEmail author
  • YuPei Chen
  • Weishan Chen
  • Cheng-Li Lin


Surgery may lead to poor blood flow and hypercoagulation. Few studies have investigated the incidence of venous thromboembolism (VTE) in Asian patients following appendectomy. We conducted a nationwide cohort study to investigate the risk of VTE in patients who underwent appendectomy compared with those who did not in Taiwan. We studied the entire hospitalized population in Taiwan from 2000 to 2012, with a follow-up period extending to the end of 2013. We identified patients who underwent appendectomy in Taiwan’s National Health Insurance Research Database as the appendectomy cohort, and selected a nonappendectomy cohort from the general population that was 4:1 frequency-matched by age (5-year interval), sex, and index year for each appendectomy case. We used Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for symptomatic VTE in the appendectomy cohort for comparison with the nonappendectomy cohort. The appendectomy cohort exhibited a higher incidence of symptomatic VTE than the nonappendectomy cohort (5.90 vs. 3.29 per 10,000 person-years). After adjustment for covariates, a 1.68-fold HR for symptomatic VTE was observed in the appendectomy cohort (95% CI 1.56–1.81). Compared with the nonappendectomy cohort, the patients who underwent open appendectomy had a 1.73-fold increased adjusted HR for symptomatic VTE (95% CI 1.61–1.87). Laparoscopic appendectomy was not significantly associated with symptomatic VTE. An 8.15-fold higher adjusted HR for VTE was observed in patients who underwent appendectomy within the first month after surgery compared with the nonappendectomy cohort. Open appendectomy carried an increased risk of symptomatic VTE. Laparoscopic appendectomy was not significantly associated with symptomatic VTE.


Venous thromboembolism Appendectomy Laparoscopic appendectomy Open appendectomy 



This study received support in part by Taichung Hospital, Ministry of Health and Welfare (107-006) and Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW107-TDU-B-212-123004). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author contributions

Conception and design: Wei-Sheng Chung; Administrative support: Wei-Sheng Chung and all authors; Collection and assembly of data: All authors; Data analysis and interpretation: all authors; Manuscript writing: All authors. Revision, reanalysis, and critical comment: Wei-Sheng Chung and Cheng-Li Lin. Final approval of manuscript: All authors.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This study obtained approval from the Institutional Review Board of China Medical University Hospital (CMUH-104-REC2-115), Taiwan.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Wei-Sheng Chung
    • 1
    • 2
    • 3
    Email author
  • YuPei Chen
    • 4
    • 5
  • Weishan Chen
    • 4
    • 5
  • Cheng-Li Lin
    • 4
    • 5
  1. 1.Department of Internal MedicineMinistry of Health and WelfareTaichung CityTaiwan
  2. 2.Department of Health Services AdministrationChina Medical UniversityTaichungTaiwan
  3. 3.Department of Healthcare AdministrationCentral Taiwan University of Science and TechnologyTaichungTaiwan
  4. 4.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  5. 5.College of MedicineChina Medical UniversityTaichungTaiwan

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