Perioperative Venous Thromboembolism in Patients Undergoing Hysterectomy for Fibroids: A Nationwide Sample

Abstract

<h3>Study Objective</h3> Venous thromboembolism (VTE) occurs in 0.4-0.7% of benign hysterectomies. Pelvic vascular compression secondary to fibroids may represent a mechanism for elevated VTE risk. We aimed to evaluate the incidence and timing of VTE among women undergoing hysterectomy for fibroids and other benign indications. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> Vizient clinical database. <h3>Patients or Participants</h3> Adult women without thrombophilias who underwent benign hysterectomy between January 2015-December 2021. <h3>Interventions</h3> VTE included pulmonary embolism or deep venous thrombosis diagnosed during four time periods: 1) preoperative remote (6 weeks to 1 year before surgery), 2) preoperative acute (6 weeks before surgery), 3) perioperative (6 weeks after surgery), and 4) postoperative remote (6 weeks to 1 year after surgery). Demographics, comorbidities, surgical characteristics, and VTE rates were compared by surgical indication. <h3>Measurements and Main Results</h3> A total of 439,705 patients were identified (248,744 with fibroids and 190,961 without), and 0.98% (4,293) experienced VTE during the study period. On univariate analysis, individuals with fibroids were more likely than those without fibroids to have VTE during the preoperative remote (0.27% vs 0.22%, p<0.001), preoperative acute (0.27% vs. 0.19%, p<0.001), and perioperative periods (0.39% vs. 0.32%, p<0.001). On multivariable logistic regression adjusting for demographics, comorbidities, uterine weight < or ≥250g, and VTE prophylaxis, the presence of fibroids was associated with increased odds of VTE in the preoperative acute period (aOR 1.29, 95% CI 1.13 - 1.49, p<0.001). In contrast, the presence of fibroids was associated with reduced odds of VTE in the postoperative remote period (aOR 0.87, 95% CI 0.78-0.96, p=0.008). <h3>Conclusion</h3> In a nationwide database, patients with fibroids undergoing hysterectomy were more likely than those with other indications to have VTE diagnosed before surgery. VTE risk was not increased postoperatively and may reflect appropriate use of prophylactic VTE measures in this patient population.