Venous thromboembolism in women undergoing pelvic reconstructive surgery with mechanical prophylaxis alone

• Published in: International Urogynecology Journal Vol. 25; no. 7; pp. 921 - 926
• Main Authors: Montoya, T. Ignacio, Leclaire, Edgar L., Oakley, Susan H., Crane, Andrea K., Mcpencow, Alexandra, Cichowski, Sara, Rahn, David D.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-07-2014; Springer Nature B.V
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Case-Control Studies; Female; Gynecologic Surgical Procedures - methods; Gynecology; Humans; Intermittent Pneumatic Compression Devices; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Original Article; Pelvis - surgery; Perioperative Period; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Retrospective Studies; Risk Factors; Urology; Venous Thromboembolism - diagnosis; Venous Thromboembolism - epidemiology; Venous Thromboembolism - prevention & control; Urogynecological surgery; Venous thromboembolism; Mechanical VTE prophylaxis
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-013-2315-4

Introduction and hypothesis
The objective of this study was determine the frequency of symptomatic perioperative venous thromboembolism (VTE) and risk factor(s) associated with VTE occurrence in women undergoing elective pelvic reconstructive surgery using only intermittent pneumatic compression (IPC) for VTE prophylaxis.
Methods
A multi-center case–cohort retrospective review was conducted at six clinical sites over a 66-month period. All sites utilize IPC as standard VTE prophylaxis for urogynecological surgery. VTE cases occurring during the same hospitalization and up to 6 weeks postoperatively were identified by ICD9 code query. Four controls were temporally matched to each case. Information collected included demographics, medical history, route of surgery, operative time, and intraoperative characteristics. Univariate and multivariate backward stepwise logistic regression analyses were performed to identify potential risk factors for VTE.
Results
Symptomatic perioperative VTE was diagnosed in 27 subjects from a cohort of 10,627 women who underwent elective urogynecological surgery (0.25 %). Univariate analysis identified surgical route (laparotomy vs others), type of surgery (“major” vs “minor”), history of gynecological cancer, surgery time, and patient age as risk factors for VTE (
P
 < 0.05). Multivariate analysis identified increased frequency of VTE with laparotomy, age ≥ 70, and surgery duration ≥ 5 h.
Conclusions
In our study cohort, the frequency of symptomatic perioperative VTE was low. Laparotomy, age ≥ 70 years, and surgery duration ≥ 5 h were associated with VTE occurrence.