Incidence and Clinical Correlates of 30-Day Thrombotic Events After Laparoscopic Cholecystectomy: An ACS-NSQIP Cohort Study

METHODS We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program from 2018 through 2022. Adults undergoing laparoscopic cholecystectomy without intraoperative cholangiography (CPT 47562) were included. Separate multivariable logistic regression models were used as exploratory association analyses. The revised candidate variable set was entered simultaneously; multiplicity was not adjusted. Laboratory, nonlinear-term, penalized-regression, and operative-year sensitivity analyses were used to assess robustness where feasible. RESULTS Among 222,530 patients with complete status for all four outcomes, 989 (0.44%; 95% CI 0.42%-0.47%) experienced at least one thrombotic event. MI occurred in 353 (0.16%), DVT in 343 (0.15%), PE in 267 (0.12%), and stroke in 115 (0.052%). In adjusted analyses, venous outcomes were associated with combinations of disseminated cancer, inpatient surgery, acute systemic illness, functional dependence, higher ASA class, older age, higher BMI, and longer operative time. MI and stroke were associated primarily with baseline cardiovascular, metabolic, and physiologic vulnerability. Operative-year adjustment did not materially change the principal associations. Postoperative transfusion within 72hours occurred in 0.49% and return to the operating room in 0.82% of the source cohort. CONCLUSION Thirty-day thrombotic events after laparoscopic cholecystectomy were uncommon, but their occurrence was concentrated in clinically recognizable higher-risk contexts. These adjusted associations are exploratory and do not constitute a validated prediction rule or establish prophylaxis thresholds. Established perioperative VTE and cardiac risk-assessment practices should remain the basis for clinical decisions.