Risk factors for venous thromboembolism after hysterectomy.

objectiveTo assess the prevalence of and risk factors for venous thromboembolism after hysterectomy.

methodsThis is a retrospective analysis of data from a voluntary, statewide surgical quality improvement collaborative. Demographics and perioperative data were obtained for hysterectomies performed from January 1, 2008, to April 4, 2014. Postoperative venous thromboembolism was defined as a deep vein thrombosis, pulmonary embolism, or both diagnosed within 30 days of hysterectomy. Significant variables related to postoperative venous thromboembolism were identified using bivariate analyses, and then logistic mixed modeling was used to develop a final model for venous thromboembolism.

resultsThe rate of postoperative venous thromboembolism was 0.5% (110/20,496). Women who had a postoperative venous thromboembolism more frequently had a body mass index 35 or greater (40.0% compared with 25.2%, odds ratio [OR] 1.96, 95% confidence interval [CI] 1.08-3.56, P=.03), abdominal hysterectomy (referent nonabdominal hysterectomy; 61.8% compared with 29.9%, OR 2.67, 95% CI 1.46-4.86, P=.001), and gynecologic cancer as the indication for surgery (16.4% compared with 9.6%, OR 2.49, 95% CI 1.22-5.07, P=.01). Increasing surgical time (hours; referent 1 hour; OR 1.55, 95% CI 1.31-1.84, P<.001) was also an associated factor. In bivariate analyses, women with, compared with without, venous thromboembolism more frequently received both preoperative and postoperative heparin (31.9% compared with 15.2%, P<.001 and 55.9% compared with 33.5%, P<.001, respectively), but this did not remain significant in the final model.

conclusionBody mass index 35 or greater, abdominal hysterectomy, increasing surgical time, and cancer as the indication for surgery are risk factors for venous thromboembolism after hysterectomy. LEVEL OF EVIDENCE: III.