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Incidence of Venous Thromboembolism After Different Modes of Gynecologic Surgery

Jorgensen, Elisa M., MD; Li, Anjie, MD; Modest, Anna M., PhD, MPH; Leung, Katherine, MPH; Moore Simas, Tiffany A., MD, MPH; Hur, Hye-Chun, MD, MPH

doi: 10.1097/AOG.0000000000002918
Surgery: Original Research: PDF Only

OBJECTIVE: To evaluate the incidence of postoperative venous thromboembolism after gynecologic surgery by mode of incision.

METHODS: We conducted a retrospective cohort study of all patients who underwent gynecologic surgery from May 2006 to June 2015 at two tertiary care academic hospitals in Massachusetts. Billing and diagnosis codes were used to identify surgeries and cases of venous thromboembolism.

RESULTS: A total of 43,751 surgical encounters among 37,485 individual patients were noted during the study. The overall incidence of venous thromboembolism is 0.2% for all gynecologic surgeries, 0.7% for hysterectomy, and 0.2% for myomectomy. Compared with patients undergoing laparotomy, patients who underwent minimally invasive gynecologic surgery were less likely to develop venous thromboembolism (laparoscopy risk ratio 0.22, 95% CI 0.13–0.37; vaginal surgery risk ratio 0.07, 95% CI 0.04–0.12). This effect persisted when data were adjusted for other known venous thromboembolism risk factors such as age, race, cancer, medical comorbidities, use of pharmacologic thromboprophylaxis, admission status, and surgical time.

CONCLUSION: Minimally invasive surgery is associated with a decreased risk of venous thromboembolism in patients undergoing gynecologic surgery, including hysterectomy and myomectomy. Although society guidelines and risk assessment tools do not currently account for mode of surgery when assessing venous thromboembolism risk and recommendations for prevention, there is a small but growing body of evidence in both general and gynecologic surgery literature that surgical approach affects a patient's risk of postoperative venous thromboembolism. Mode of surgery should be considered when assessing venous thromboembolism risk and planning venous thromboembolism prophylaxis for patients undergoing gynecologic surgery.

Venous thromboembolism occurs in approximately 0.2% of all gynecologic surgeries, with a decreased risk in minimally invasive compared with open surgical approaches.

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Packard Children's Health Alliance, Stanford Medicine, Stanford, California; and the University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.

Corresponding author: Hye-Chun Hur, MD, MPH, Department of Obstetrics & Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16-127, New York, NY 10032; email: hh2760@cumc.columbia.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 46th American Association of Gynecologic Laparoscopists Global Congress, November 12–16, 2017, National Harbor, Maryland.

Each author has indicated that she has met the journal's requirements for authorship.

Received May 29, 2018

Received in revised form July 19, 2018

Accepted July 26, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.