Venous Thromboembolism in Women Undergoing Pelvic Reconstructive Surgery With Mechanical Prophylaxis Alone

Abstract

Venous thromboembolism (VTE) is a major postoperative complication associated with significant patient morbidity and mortality. Surgical patients can be stratified into different risk categories for a VTE event based on age, duration of surgery, and other clinical characteristics. Women undergoing pelvic reconstructive surgery are considered to be a high-risk group because they are generally older, and their procedures are associated with prolonged operative times. Although reported rates of VTE are low in women undergoing this type of surgical procedure, the substantial clinical impact and cost associated with a VTE event highlight the need to identify patients at high risk. Recommendations for perioperative VTE prophylaxis include postoperative ambulation in patients at low risk and the use of intermittent pneumatic compression (IPC) devices with or without pharmacological thromboprophylaxis in those at higher risk. The primary aim of this multicenter case-cohort retrospective study was to determine the frequency of symptomatic perioperative VTE and identify risk factors associated with its development among women undergoing elective pelvic reconstructive surgery who received IPC alone as VTE prophylaxis The study was conducted at 6 sites in the United States over a 66-month period (January 2006 to June 2011). At all sites, patients undergoing urogynecologic surgery were given standard IPC devices alone as VTE prophylaxis. Cases were defined as surgical patients who experienced symptomatic VTE during the same hospitalization and up to 6 weeks postoperatively. Cases were identified by the International Classification of Diseases, Ninth Revision hospital diagnosis codes. Each case was temporally matched to 4 control subjects. Data collected included demographics, medical history, surgical route, operative time, and intraoperative characteristics. Potential risk factors for VTE were assessed using univariate and multivariate backward stepwise logistic regression analysis. Twenty-seven patients (0.25%) among a cohort 10,627 who underwent elective urogynecologic surgery had a diagnosis of symptomatic perioperative VTE. Univariate analysis identified patient age, surgical approach (laparotomy vs other routes), type of surgery (major vs minor), history of gynecologic cancer, and duration of surgery as risk factors for VTE (all P < 0.05). In multivariate analysis, risk factors associated with increased frequency of VTE were laparotomy (P = 0.03), age 70 years or older (P = 0.036), and operative time 5 hours or longer (P = 0.025). These data show that the frequency of symptomatic perioperative VTE is very low in patients having urogynecologic surgery. Risk factors for VTE identified in multivariate analysis include laparotomy, patient age 70 years or older, and duration of surgery 5 hours or longer.