P04 The relationship between air travel and postoperative venous thromboembolism: a systematic review and meta-analysis

Abstract

Abstract Introduction Surgery is a well-established risk factor for venous thromboembolism (VTE), with fatal pulmonary embolism (PE) remaining the most common preventable death in post-operative patients. Air travel has also been identified as an independent risk factor for VTE, however, there is no guidance on whether air travel in addition to surgery exacerbates this risk. With the increased rates of health tourism, patients increasingly fly to seek surgical intervention. This systematic review and meta-analysis pools published literature to estimate the additional risk of recent air travel after surgery. Methods Articles reporting post-operative VTE incidence in adults with recent air travel were included in our review with data pooled using fixed and random effects. Our primary outcome measured the pooled VTE risk. Results Seven retrospective studies were included with a total of 24975 patients. The odds ratio (OR) of VTE in the flying plus surgery group was 1.96 (95%CI 0.54-7.08). In subgroup analysis of patients with over 4 hours of air travel, odds of VTE were 2.35 (95%CI 0.29-19.36). The incidence of DVT and PE specifically was 0.67% (95%CI 0.31%-1.51%) and 0.41% (95%CI 0%-1.29%) respectively in the flying and surgery group and 0.45% (95%CI 0.10%-2.00%) and 0.55% (95%CI 0.31%-0.86%) in the surgery alone group. Conclusion The meta-analysis demonstrates heterogeneity in studies and a very low certainty of evidence overall considering imprecision and observational study designs. Whilst results did not demonstrate significant increase in VTE risk, further studies should propensity match patients in the cohort to reduce the effect of confounding.