The nurse recognizes that the client recovering from which of these surgeries is at highest risk for pulmonary embolism?

A. A laparoscopic cholecystectomy is a minimally invasive procedure associated with shorter operative times and faster postoperative mobilization. While all surgeries carry some risk of VTE, the limited tissue trauma and early ambulation characteristic of this procedure result in a lower risk compared to major abdominal or thoracic surgeries. It is not the highest-risk surgery among the choices provided. B. A subtotal thyroidectomy involves the neck area and is generally not associated with prolonged immobility or significant venous stasis in the lower extremities. The procedure is relatively localized and does not typically involve the large-scale systemic inflammation or the prolonged bed rest seen in major abdominal resections. The risk of pulmonary embolism following this surgery is clinically considered to be low. C. An open appendectomy is a traditional abdominal surgery, but the surgical site is localized and the procedure is usually brief. While it carries more risk than a laparoscopic approach, it does not involve the extensive tissue manipulation or the prolonged recovery time seen in more complex gastrointestinal surgeries. Consequently, the risk for pulmonary embolism, although present, is not the highest in this group. D. A total gastrectomy is a major, extensive abdominal surgery that involves significant tissue trauma and requires a prolonged period of postoperative recovery and immobility. The length of the surgery and the complexity of the resection increase the risk of venous stasis and the activation of the coagulation cascade. Patients undergoing major gastrointestinal resections are at the highest risk for developing deep vein thrombosis and subsequent pulmonary embolism.