Incidence of and Risk Factors Associated with Postoperative Venous Thromboembolism in Hysterectomy for Benign Indications

STUDY OBJECTIVE: To identify the incidence of venous thromboembolism (VTE) and its modifiable risk factors after hysterectomy for benign conditions. DESIGN: Retrospective cohort. SETTING: American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) 2014 to 2018 Participant Use Data Files. PATIENTS OR PARTICIPANTS: Women undergoing hysterectomy for benign indications identified by Current Procedural Terminology and International Classification of Diseases codes. INTERVENTIONS: Hysterectomy cases were stratified by approach (abdominal, laparoscopic, or vaginal). Outcomes were VTE, including deep vein thrombosis or pulmonary embolism. Patient demographics, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification system scores, operative time, length of stay, surgeon subspecialty, readmission, and reoperation were also collected. The student t-test, Χ(2) and Fisher exact tests were used for univariate analysis where appropriate; multivariable logistic regression models were also performed. MEASUREMENTS AND MAIN RESULTS: We identified 92,272 cases during the study period, of which 23,388 (25.3%) were abdominal hysterectomies (AH), 53,968 (58.5%) were laparoscopic hysterectomies (LH), and 14,916 (16.2%) were vaginal hysterectomies (VH). The overall incidence of VTE was 0.4%. The incidence of VTE was 0.7% in AH, 0.3% in LH, and 0.2% in VH (p<0.001). In a multivariable logistic regression model controlling for age, race, BMI, smoking status, ASA class and route of surgery, LH and VH were associated with a lower odds of postoperative VTE (aOR 0.48, 95%CI 0.38-0.60 and aOR 0.31, 95%CI 0.20-0.46, respectively) while ASA class 4 (aOR 4.3; 95%CI 1.93-9.19) and total operative time >130 minutes (aOR 1.71, 95%CI 1.38-2.14) were independently associated with an increased odds of postoperative VTE. CONCLUSION: The incidence of postoperative VTE after hysterectomy for benign indications was low. The adjusted odds of VTE was higher in patients undergoing abdominal hysterectomy when compared to laparoscopic and vaginal approaches. Surgeons should consider a minimally invasive approach for hysterectomy for benign conditions when feasible to decrease the risk of postoperative VTE.