The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study

Background: Surgery is a well-known risk factor for venous thromboembolism (VTE). However, for several minor surgical procedures, thromboprophylaxis is not advised.Objectives: These low-risk procedures include a wide variation of interventions for which we estimated the VTE risk to verify their low-risk status.Patients/Methods: We used data from a large population-based case-control study (Multiple Environment and Genetic Assessment study) into causes of VTE, and linked these to the Dutch Hospital Data Registry to identify exposure to surgical procedures. Logistic regression was used to calculate odds ratios for the 90-day and 1-year relative risks of VTE following these procedures, which were adjusted for body mass index (BMI), sex, age, comorbidities, and infection/inflammation.Results: We included 4247 patients with VTE and 5538 control subjects. Median age and BMI were 48.5 years and 25.5 m2/kg, respectively. Nine unique procedures or groups of procedures were analyzed. One hundred twenty-three participants-90 cases and 33 controls-had undergone a minor procedure within 90 days of the index date, resulting in a 3.5-fold (OR, 3.5; 95% CI, 2.3-5.3) overall increased VTE risk. Further-more, venous stripping (OR, 7.2; 95% CI, 2.4-21.2), open abdominal/inguinal hernia repair (OR, 3.7; 95% CI, 1.2-11.6), and laparoscopic cholecystectomy (OR, 3.2; 95% CI, 1.0-10.6) were associated with an increased risk. Other minor procedures were less strongly or not associated with an increased risk. In the 1-year period before the index date, all odds ratios were lower.Conclusion: Of the low-risk procedures, we found that venous stripping, open abdominal/inguinal hernia repair, and laparoscopic cholecystectomy were associated with a clearly increased risk of VTE within 90 postoperative days.

Automated summary

This study analyzed the influence of different surgical procedures on the risk of VTE. The results showed that although the VTE risk was generally low for most minor surgical procedures, venous stripping, open abdominal/inguinal hernia repair, and laparoscopic cholecystectomy were associated with a significantly increased risk of VTE within 90 postoperative days. These findings suggest the need for enhanced VTE prevention when performing these surgeries.