Perioperative venous thromboembolism risk in patients undergoing hysterectomy for fibroids: a U.S. retrospective cohort study

Objective: Venous thromboembolism (VTE) occurs in 0.4-0.7% of benign hysterectomies. Pelvic vascular compression secondary to fibroids may represent a mechanism for elevated VTE risk. We aimed to evaluate the incidence and timing of VTE among individuals undergoing hysterectomy for fibroids and other benign indications. Design: Retrospective cohort. Setting: Vizient clinical database. Population: Adult patients without thrombophilias or malignancies who underwent hysterectomy January 2015-December 2021. Methods: : Demographics, comorbidities, surgical characteristics, and VTE rates were compared by surgical indication. Main Outcome Measures: VTE consisted of pulmonary embolism or deep venous thrombosis diagnosed during three periods: 1) preoperative (one year before surgery until day before surgery), 2) early postoperative (surgery date through six weeks after surgery), and 3) late postoperative (six weeks to one year after surgery). Results: : 467,027 patients were identified (263,844 with fibroids and 203,183 without) and 1.1% experienced VTE. On multivariable regressions adjusting for demographic confounders and route of surgery, the presence of fibroids was associated with higher odds of preoperative (aOR 1.12, 95% CI 1.03-1.22, p=0.011) and lower odds of late postoperative VTE (aOR 0.81, 95% CI 0.73-0.91, p<0.001). For individuals with fibroids, uterine weight ≥250 grams and undergoing hysterectomy via laparotomy were associated with preoperative (aOR 1.29, 95% CI 1.09-1.52, p=0.003 and aOR 2.32, 95% CI 2.10-2.56, p<0.001) and early postoperative VTE (aOR 1.32, 95% CI 1.08-1.62, p=0.006 and aOR 1.72, 95% CI 1.50-1.96, p<0.001), respectively. Conclusion: Patients with fibroids were at higher odds of having VTE in the year before hysterectomy. For those with fibroids, elevated uterine weight and open hysterectomy were associated with greater risk of preoperative and early postoperative VTEs. Funding There was no funding source for this study.