Effects of Pharmacologic Venous Thromboembolism (VTE) Prophylaxis in Benign Minimally Invasive Hysterectomy

• Published in: Journal of minimally invasive gynecology Vol. 27; no. 7; p. S2
• Main Authors: Travieso, J., Kamdar, N., Morgan, D.M., As-Sanie, S., Till, S.R.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2020
• ISSN: 1553-4650; 1553-4669
• DOI: 10.1016/j.jmig.2020.08.027

To evaluate if the addition of pharmacologic prophylaxis (heparin, low molecular weight heparin) for VTE is associated with adverse perioperative outcomes in minimally invasive surgery (MIS) hysterectomy for benign indications compared to mechanical prophylaxis alone.
Retrospective cohort study.
Michigan Surgical Quality Collaborative (MSQC).
Patients who underwent a benign MIS hysterectomy (i.e. laparoscopic, vaginal, laparoscopic-assisted vaginal, or robotic-assisted laparoscopy) performed between July 2012 and June 2015 and received mechanical prophylaxis for thromboembolism.
Patients were divided into cohorts who received mechanical prophylaxis alone (MPpx) or mechanical + pharmacologic prophylaxis (M+Pppx). Propensity score matching was used to minimize confounding due to differences in age, race, body mass index>40, hypertension, congestive heart failure, smoking, functional status, preoperative transfusion, preoperative anemia or thrombocytopenia, length of stay, and hospital teaching status. Outcomes evaluated in the propensity-matched cohorts were estimated blood loss, intraoperative time, postoperative blood transfusion, postoperative VTE, surgical site infection, reoperation, and readmission.
There were 1944 matched pairs of patients in the Mppx and M+Pppx cohorts. Intraoperative time was 21 minutes longer (168 minutes ± 63 min vs 189 ± 75 mins, p<.0001) in the M+Pppx cohort. There were no significant differences in estimated blood loss (Mppx: 122cc ± 156cc vs M+Pppx: 132cc ± 179, p=0.08), postoperative transfusion (0.71% v 0.67%, p=.74), or VTE (0.16% and 0.21%, p=.67). There were also no differences in surgical site infection, re-operation, or re-admission.
Further research is needed into the addition of pharmacologicprophylaxis to mechanical prophylaxis and its association with longer operative time for benign minimally invasive hysterectomy. Given extremely low rates of VTE in both groups and no difference detected in other significant peri-operative outcomes using a large database, it seems reasonable to question routine use of pharmacologic prophylaxis in these patients.