814 Association between peripartum hysterectomy and venous thromboembolism

Abstract

The risk of venous thromboembolism (VTE) postpartum is modified by mode of delivery, with the risk of VTE being higher after cesarean compared to vaginal delivery. The risk of VTE following peripartum hysterectomy is largely unknown. The objective of this study was to compare the incidence and risk of VTE among women who had and did not have a peripartum hysterectomy. This is an observational study using data from the Nationwide Readmission Database from 10/2015 to 12/2017. Delivery encounters and all variables of interest were identified using ICD-10 diagnosis and procedure codes. The incidence of VTE during the delivery encounter to within 6 weeks of discharge was compared among women who had and did not have a peripartum hysterectomy. Multivariable logistic regressions were used to estimate associations between VTE and hysterectomy, adjusted for patient characteristics known to be associated with VTE risk. Analyses used survey weights to obtain population estimates. P-values <0.05 were considered significant. Of the 4,419,037 women with deliveries, 5,098 (115 per 100,000 deliveries) underwent hysterectomy. 110 were diagnosed with VTE after hysterectomy, of which 87 (79%) occurred during the delivery admission. The incidence of VTE was significantly higher in women who did vs. did not undergo peripartum hysterectomy: 2,153.4 vs. 87.7 per 100,000 deliveries (p<0.001). The adjusted odds of VTE in women after hysterectomy was significantly higher compared to women who had a vaginal or cesarean delivery and no hysterectomy (Table 1). Characteristics between patients who underwent peripartum hysterectomy with and without VTE did not differ significantly, suggesting there may be limited need for further VTE risk stratification after a hysterectomy (Table 2). Pregnancy-related hysterectomy is associated with significantly increased risk of VTE in the postpartum period. These findings prompt further investigation into the role for routine VTE prophylaxis in the postpartum period extending beyond the delivery hospitalization as a risk-reducing strategy after hysterectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)