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

Mark J R Smeets; Carolina E Touw; Frits R Rosendaal; Banne Nemeth; Suzanne C Cannegieter

doi:10.1016/j.jtha.2022.11.035

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

J Thromb Haemost. 2023 Apr;21(4):975-982. doi: 10.1016/j.jtha.2022.11.035. Epub 2022 Dec 22.

Authors

Mark J R Smeets¹, Carolina E Touw¹, Frits R Rosendaal¹, Banne Nemeth², Suzanne C Cannegieter³

Affiliations

¹ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
² Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Internal Medicine, section Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.c.cannegieter@lumc.nl.

PMID: 36696214
DOI: 10.1016/j.jtha.2022.11.035

Abstract

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. Furthermore, 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.

Keywords: case-control studies; epidemiology; minor surgical procedures; risk assessment; venous thromboembolism.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anticoagulants / adverse effects
Case-Control Studies
Hernia, Inguinal* / complications
Hernia, Inguinal* / drug therapy
Humans
Postoperative Complications / drug therapy
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Risk Factors
Venous Thromboembolism* / diagnosis
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology

Substances

Anticoagulants