提供腹部手术后症状性静脉血栓栓塞（VTE）和大出血的程序特异性估计。药物性抗凝治疗的使用代表着一种权衡，取决于不同手术间VTE和出血风险的差异；它们的程度仍不确定。我们确定了在腹部手术后报告程序特异性VTE或大出血风险的观察性研究；调整了报告的估计值以考虑抗凝治疗和随访时间的长度；并估计了手术后4周的累计发病率，根据VTE风险组进行分层，并评价了证据确定度。经过资格筛选，285项研究（8,048,635名患者）报告了40种一般腹部手术、36种结肠直肠手术、15种上消化道手术和24种肝胆胰手术程序的资格。VTE的风险在不同手术中存在明显差异：在一般腹部手术中，从腹腔镜胆囊切除的中位数＜0.1％到开腹小肠切除的中位数3.7％；在结肠直肠手术中，从微创乙状结肠切除的0.3％到紧急开放性全直肠切除的10.0％；在上消化道/肝胆胰手术中，从腹腔镜胃切除的0.2％到开腹肝脏尾部切除癌症的6.8％。VTE抗凝治疗通过减少VTE风险并稍微增加出血风险为某些手术（例如开腹结肠切除术，开腹胰十二指肠切除术）提供净益，而在其他手术（例如腹腔镜胆囊切除术，选择性腹股沟疝修补术）中正好相反。在许多手术中，血栓栓塞和出血风险相似，决策取决于个体风险预测以及对VTE和出血的价值和偏好。版权所有 © 2023 作者。由 Wolters Kluwer Health, Inc. 发布。

To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding following abdominal surgery.Use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery; adjusted the reported estimates for thromboprophylaxis and length of follow-up; and estimated cumulative incidence at 4 weeks post-surgery, stratified by VTE risk groups; and rated evidence certainty.After eligibility screening, 285 studies (8,048,635 patients) reporting on 40 general abdominal, 36 colorectal, 15 upper-gastrointestinal, and 24 hepatopancreatobiliary surgery procedures proved eligible. Evidence certainty proved generally moderate or low for VTE and low or very low for bleeding requiring reintervention. The risk of VTE varied substantially between procedures: in general abdominal surgery from a median of <0.1% in laparoscopic cholecystectomy to a median of 3.7% in open small bowel resection; in colorectal from 0.3% in minimally-invasive sigmoid colectomy to 10.0% in emergency open total proctocolectomy; and in upper-gastrointestinal/hepatopancreatobiliary from 0.2% in laparoscopic sleeve gastrectomy to 6.8% in open distal pancreatectomy for cancer.VTE thromboprophylaxis provides net benefit through VTE reduction with small increase in bleeding in some procedures (e.g., open colectomy, open pancreaticoduodenectomy), whereas the opposite is true in others (e.g., laparoscopic cholecystectomy, elective groin hernia repairs). In many procedures, thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.