Written by Denrick Cooper
Some minor surgical procedures still carry an increased risk of venous thromboembolism postoperatively.
Why does this matter?
Risk of venous thromboembolism (VTE) following “low-risk” surgical procedures is not well understood. This article explores the association of various procedures with postoperative VTE at 90 days and 1 year.
Low risk procedure? …You sure about that? Are you sure about that? You SURE about that?!
These data were extracted from a prior case-control dataset and cross referenced with the Dutch Hospital Registry to perform this case-control study on adult patients <70-years old (without cancer) who had undergone a surgical procedure and subsequently developed VTE (pulmonary embolism or deep venous thrombosis) between March 1999 – August 2004. There were 4,247 cases with VTE and 5,538 controls. The exposure of interest was a group of nine “low-risk” surgical procedures (for which Dutch, German, and U.S. guidelines do not recommend thromboprophylaxis), that occurred within 90 days or 1 year of the VTE event (considered the index date for the VTE group and controls).
Overall, minor surgeries had a 3.5 fold increased odds of VTE (95%CI 2.3-5.3). Procedures including venous stripping (OR 7.2, 95%CI 2.4-21.2), open abdominal/inguinal hernia repair (OR 3.7, 95%CI 1.2-11.6), and laparoscopic cholecystectomy (OR 3.2 95%CI 1.0-10.6) demonstrated significantly increased risk of VTE (see figure below).
Although the absolute risk of VTE following a minor surgical procedure was low (<0.5%), there was indeed variability among the identified surgeries, allowing a ranking in the risk. However, despite a large initial recruited population of VTE cases and non-VTE controls, only 123 participants had the exposure of interest. Also, one of the most important limitations is that authors were unaware if patients were taking long-term anticoagulation or if they received thromboprophylaxis at the time of the surgery and/or postoperatively.
Take home: These results may be useful to further refine risk estimates of postoperative VTE and to personalize the use of thromboprophylaxis in individual patients.
Peer reviewed and edited by Bo Stubblefield and Clay Smith
The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study. J Thromb Haemost. 2023 Apr;21(4):975-982. doi: 10.1016/j.jtha.2022.11.035. Epub 2022 Dec 22.