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

Montoya, T. Ignacio; LeClaire, Edgar L.; Oakley, Susan H.; Crane, Andrea K.; McPencow, Alexandra M.; Cichowski, Sara; Rahn, David D.

doi:10.1007/s00192-013-2315-4

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…Similar to findings in hysterectomy, mode of surgery was found to be a risk factor for postoperative VTE in urogynecologic procedures [38]. A large database study showed that abdominal sacrocolpopexy had a significantly higher risk of VTE compared with vaginal sacrocolpopexy [39], and a multicenter case-control study showed a risk of VTE with laparotomy in patients undergoing all types of urogynecologic procedures [40].…”

Section: Other Gynecologic Surgerysupporting

confidence: 52%

Venous Thromboembolism in Minimally Invasive Gynecologic Surgery: A Systematic Review

Jorgensen

Hur

2019

Journal of Minimally Invasive Gynecology

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Venous thromboembolism (VTE) is the leading cause of preventable healthcare-related death after surgery. Although there is a large body of research on VTE in the general population as well as risk-assessment tools, evidence specific to the current practices in gynecologic surgery is more sparse. This review article seeks to discuss current literature on VTE in gynecologic surgery, with a focus on minimally invasive surgery. Evidence on risk factors for VTE in gynecologic surgery is evaluated as well as current recommendations use of thromboprophylaxis for prevention of VTE. Despite data showing that minimally invasive gynecologic surgery independently decreases risk of VTE compared with laparotomy, current clinical risk assessment tools and guidelines do not incorporate mode of surgery into recommendations for perioperative VTE prevention.

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Section: Other Gynecologic Surgerysupporting

confidence: 52%

Venous Thromboembolism in Minimally Invasive Gynecologic Surgery: A Systematic Review

Jorgensen

Hur

2019

Journal of Minimally Invasive Gynecology

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“…In studies of patients undergoing any type of reconstructive pelvic surgery, the incidence of VTE postoperatively ranges from 0.25% to 0.3% depending on the type of approach, with the incidence of VTE in vaginal repair of POP being 0.17 specifically. 2,3 Moreover, individual risk factors for vaginal surgery alone were not identified in these studies. Vaginal pelvic organ prolapse (POP) repair is a prevalent procedure in FPMRS.…”

Section: Introductionmentioning

confidence: 84%

“…In the subspecialty of FPMRS, there is a paucity of data examining the incidence and risk factors for postoperative VTE. In studies of patients undergoing any type of reconstructive pelvic surgery, the incidence of VTE postoperatively ranges from 0.25% to 0.3% depending on the type of approach, with the incidence of VTE in vaginal repair of POP being 0.17 specifically 2,3 . Moreover, individual risk factors for vaginal surgery alone were not identified in these studies.…”

Section: Introductionmentioning

confidence: 85%

Venous thromboembolism prophylaxis in vaginal surgery for pelvic organ prolapse: Predictors of high risk in a low‐risk population

Escobar

Gomez‐Viso

Agrawal

et al. 2020

Neurourology and Urodynamics

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Aim: Venous thromboembolism (VTE) rates in vaginal pelvic organ prolapse (POP) repair are low. Our aim is to evaluate specific risk factors for VTE in patients undergoing vaginal POP repair. Methods: This is a cross-sectional study using the American College of Surgeons NSQIP database. Using CPT codes, cases of vaginal POP repair between 2014 and 2017 were identified. Patient and operative characteristics were collected. VTE was defined as pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days from surgery. Univariate analyses were performed using the Student t test for continuous and χ 2 tests for categorical variables. Multivariate logistic regression was performed to identify factors independently associated with VTE. Results: Of 44 207 women who underwent vaginal POP repair, there were 69 cases of VTE (0.16%). VTE rates for obliterative (0.15%) and functional (0.16%) vaginal POP repair, as well as for repairs with hysterectomy (0.17%) and without hysterectomy (0.12%) were not significantly different (p = .616 and .216, respectively). Multivariate analysis demonstrated predictors for postoperative VTE to be ASA physical status classification ≥ 3 (aOR, 1.99; p = .014), length of stay >75th percentile (aOR, 2.01; p = .007), operative time >3 h (aOR, 2.24; p = .007), and dyspnea (aOR, 3.26, p = .004). Conclusion: Despite the low incidence of VTE after vaginal POP repair, patients with ASA physical status classification ≥ 3, length of stay >75th percentile, operative time >3 h, and dyspnea were at higher risk for VTE. Vaginal POP repair may have independent VTE risk factors not captured in standard risk assessment tools. K E Y W O R D S deep vein thrombosis, pelvic organ prolapse, perioperative management, pulmonary embolism, vaginal repair of pelvic organ prolapse, venous thromboembolism, venous thromboembolism prophylaxis

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“…5 In women of varied risk for VTE, there is a 0.25% to 0.3% incidence of VTE occurring up to 6 weeks postoperatively after use of intermittent pneumatic compression alone for prophylaxis. 14,15 The guidelines by the ACCP and ACOG place the majority of benign gynecologic patients at “moderate” to “high” VTE risk. 6,12,16 In contrast, the Society of Gynecologic Surgeons’ Clinical Practice Guidelines suggest addition of pharmacologic prophylaxis only in patients with 2 of 3 risks (age 60 years or older, cancer history, or history of VTE).…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Pelvic Organ Prolapse Surgery in Women Using Chronic Antithrombotic Therapy

High¹,

Kavanagh²,

Khavari³

et al. 2017

Female Pelvic Med Reconstr Surg

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Introduction Chronic antithrombotic therapy is common among patients requiring surgery for pelvic organ prolapse because of age and comorbidities. The impact of chronic anticoagulation on postoperative complications in pelvic organ prolapse surgery has not been investigated. This study aims to determine if patients on chronic antithrombotic therapy are at increased risk for postoperative complications. Methods This retrospective cohort study included women having prolapse surgery from 2012 to 2015, identified by Current Procedural Terminology codes, excluding patients undergoing concomitant major nonurogynecologic procedures. Baseline characteristics were compared and all procedures performed, operative duration, estimated blood loss, and length of hospitalization. Complications (blood transfusion, intensive care unit admission, reoperation, readmission, hematoma, thromboembolic event, and infection) were compared in women on chronic antithrombotic therapy and controls. Logistic regression determined odds ratio (OR) for complications in patients on chronic antithrombotics. Complications were graded by the Clavien-Dindo classification. Results A total of 388 charts were reviewed, and 386 patients met inclusion criteria. Twenty-one of the 386 patients were on chronic anti-thrombotic therapy. Chronic antithrombotic therapy increased overall complications (OR, 6.8; P < 0.0005), blood transfusion (OR, 165; P < 0.001), intensive care unit admission (OR, 19.10; P < 0.004), hospital readmission (OR, 20.7; P < 0.0005), vaginal hematoma (OR, 554.1; P < 0.001), infection (OR, 22.44; P < 0.004), and complications that required specific additional follow-up (OR, 9.42; P < 0.0005). There were no thromboembolic events. Antithrombotic therapy did not significantly increase reoperation rates (OR, 3.8; P = 0.275). Findings were maintained when adjusting for covariates of age and body mass index. Conclusions Postoperative surgical complications after prolapse repair procedures are increased in patients who use chronic antithrombotic medication, the majority of cases are successfully managed conservatively.

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

Abstract: 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.

Cited by 12 publications

References 9 publications

Venous Thromboembolism in Minimally Invasive Gynecologic Surgery: A Systematic Review

Venous Thromboembolism in Minimally Invasive Gynecologic Surgery: A Systematic Review

Venous thromboembolism prophylaxis in vaginal surgery for pelvic organ prolapse: Predictors of high risk in a low‐risk population

Outcomes in Pelvic Organ Prolapse Surgery in Women Using Chronic Antithrombotic Therapy

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