Predictors of Symptomatic Venous Thromboembolism in Patients with Soft Tissue Sarcoma in the Lower Extremity

Simple Summary 28 patients, or 4.36%, were diagnosed with venous thromboembolism after soft tissue sarcoma surgery. The most significant risk factors for this complication were pre-operative (PTT) partial thromboplastin time, post-operative PTT, post-op chemotherapy, metastasis at diagnosis, additional surgery for metastasis or local recurrence, and tumor size larger than 10 cm. Risk of wound complications and infection increased in those who received prophylaxis medications. Orthopedic surgery and soft-tissue sarcoma (STS) both independently increase the risk of developing symptomatic venous thromboembolic events (SVTE), but there are no established risk factors or guidelines for how to prophylactically treat patients with STS undergoing surgery. The objectives of this study were to (1) identify the prevalence of SVTE in patients undergoing STS surgery, (2) identify risk factors for SVTE, and (3) determine the risk of wound complications associated with VTE prophylaxis. This retrospective study was conducted in a tertiary level, academic hospital. A total of 642 patients were treated for soft-tissue sarcoma in the lower extremity with follow up for at least 90 days for the development of SVTE such as deep venous thrombosis and pulmonary embolism. Multivariate logistic regression was used to identify predictors for these events by controlling for patient characteristics, surgical characteristics, and treatment variables, with significance held at p < 0.05. Twenty eight patients (4.36%) were diagnosed with SVTE. Multivariate analysis found six significant predictors ordered based on standardized coefficients: pre-operative (PTT) partial thromboplastin time (p < 0.001), post-operative PTT (p = 0.010), post-op chemotherapy (p = 0.013), metastasis at diagnosis (p = 0.025), additional surgery for metastasis or local recurrence (p = 0.004), and tumor size larger than 10 cm (p < 0.001). The risk of wound complications (p = 0.04) and infection (p = 0.017) increased significantly in patients who received chemical prophylaxis. Our study identifies risk factors for patients at increased risk of developing VTE. Further prospective research is necessary to identify which protocols would be beneficial in preventing SVTE in high-risk patients with a low profile of wound complications.

Automated summary

This study found that 4.36% of patients undergoing soft tissue sarcoma surgery developed venous thromboembolism (VTE), with significant risk factors including pre-operative and post-operative partial thromboplastin time (PTT), post-op chemotherapy, metastasis at diagnosis, additional surgery for metastasis or local recurrence, and tumor size larger than 10 cm. The use of prophylaxis medications increased the risk of wound complications and infection. Therefore, there is a need for further research to establish risk factors and guidelines for prophylactic treatment of VTE in patients undergoing soft tissue sarcoma surgery.