Incidence and risk factors for venous thromboembolic events after different routes of pelvic organ prolapse repairs

Venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common cause of preventable deaths in hospitalized patients in the United States. Although the risk of VTE in benign gynecologic surgery is generally low, the potential for VTE in urogynecologic population is significant because the majority of patients undergoing Pelvic Organ Prolapse (POP) surgery have increased surgical risk factors. To investigate incidence and risk factors for VTE within 30-days after different routes of POP surgery in a large, cohort population using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). This was a retrospective-cohort study utilizing Current Procedural Terminology (CPT) codes to identify POP repairs with and without concurrent hysterectomy performed during 2011-2017 in the ACS-NSQIP database. Demographics, preoperative length of hospital stay, operative time, preoperative comorbidities, smoking status, American Society of Anesthesiologists (ASA) classification system scores, along with other variables were collected. Postoperative 30-day complications, including readmission, reoperation, and mortality were collected. The incidence rates of VTE, as defined by ACS-NSQIP, were compared among different surgical routes. Descriptive statistics were utilized, and logistic regression was performed to identify associations. Among 91,480 POP surgeries identified, 63,108 were analyzed: 43,279 (68.6%) were performed vaginally; 16,518 (26.2%) laparoscopically; and, 3,311 (5.2%) abdominally. 34,698 (55.0%) underwent a concurrent hysterectomy. One hundred-thirty-three out of 63,108 subjects developed VTE within 30-days after surgery (0.21%; 95% Confidence Interval [CI], 0.18-0.25, p