Risk of venous thromboembolism in patients undergoing surgery for pelvic organ prolapse

Introduction and hypothesis: We sought to determine the incidence of venous thromboembolism (VTE) in patients undergoing surgery for pelvic organ prolapse (POP) based on surgical approach. Methods: The American College of Surgeons National Quality Improvement Program (NSQIP) database was used to select all surgeries performed for POP from 2005 to 2013. CPT-4 codes were grouped based on surgical approach: vaginal (VAG), laparoscopic sacrocolpopexy (LSC), or open abdominal sacrocolpopexy (ASC). Patient demographics, preoperative American Society of Anesthesiologists (ASA) classification system scores, and 30-day postoperative complications were obtained. Results: Of the 26,103 women who underwent surgery for POP, 21,311 (81.7 %) underwent VAG, 3,346 (12.8 %) LSC, and 1,426 (5.5 %) ASC. VTE occurred in 36 patients (0.17 %) in the VAG group, 8 (0.24 %) in the LSC group, and 9 (0.63 %) in the ASC group. The ASC group had a significantly higher incidence of VTE compared with the VAG group (p <0.01). Upon multivariate analysis, factors associated with a greater incidence of VTE included BMI greater than 30 kg/m² (p = 0.048), ASA score of 3, 4, or 5 (p = 0.027), and length of stay above the 75th percentile (p <0.01). The procedure group did not retain statistical significance in multivariate modeling. Conclusions: Venous thromboembolism is rare following surgery for POP. Although differences in VTE rates between procedure groups failed to maintain statistical significance after multivariate analysis, we were able to identify risk factors associated with an increased VTE risk in surgery for POP. Women with obesity, an increased length of stay, or ASA score of 3 or higher are at an increased risk for developing VTE after undergoing surgery for POP.