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Trends in venous thromboembolism prophylaxis in gynecologic surgery for benign and malignant indications

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Venous thromboembolism (VTE) is a leading cause of perioperative morbidity and mortality. We analyzed the trends in use of VTE prophylaxis over time in women undergoing hysterectomy for both benign and malignant indications.

Methods

The Premier Database was used to identify women who underwent hysterectomy from 2011 to 2017. Women were stratified by indication for surgery (benign or malignant) and route of hysterectomy. VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination (mechanical and pharmacologic). Trends in use of prophylaxis over time were analyzed. Multivariate models were developed to examine predictors of use of prophylaxis.

Results

Among 920,477 patients identified, 579,824 (63.0%) received VTE prophylaxis, including 15.4% who received pharmacologic, 34.5% who received mechanical, and 13.1% who received combination prophylaxis. Overall use of prophylaxis declined annually from 68.1% in 2011 to 56.7% in 2017 (P < 0.001). Among patients with cancer, the use of prophylaxis declined from 84.5% in 2011 to 78.6% in 2017 (P < 0.001). A similar trend was noted among women with benign conditions, with rates of prophylaxis declining from 66.2 to 53.3% (P < 0.001). Additionally, use of prophylaxis declined for patients undergoing MIS hysterectomy from 65.4% in 2011 to 53.3% in 2017, and from 73.1 to 66.7% in patients who underwent abdominal hysterectomy. Among patients with cancer, rates of pharmacologic and combined prophylaxis was 70.9% in 2011 and 69.7% in 2017. However, among women with benign conditions, the rates of pharmacologic and combined prophylaxis rose from 19.4% in 2011 to 25.6% in 2017 (P < 0.001). Despite these changes in prophylaxis rates and methods, there was no significant change in the rate of VTE between 2011 and 2017 (P = 0.06).

Conclusion

Despite the lack of change in guidelines for VTE prophylaxis in gynecologic surgery, the overall rates of prophylaxis decreased over time independent of the indication or route of surgery. The rates of thromboembolic events did not significantly increase in response to the decreased use of VTE prophylaxis.

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References

  1. Cantrell LA, Garcia C, Maitland HS (2018) Thrombosis and thromboprophylaxis in gynecology surgery. Clin Obstet Gynecol 61:269–277

    PubMed  Google Scholar 

  2. Cohen A, Lim CS, Davies AH (2017) Venous thromboembolism in gynecological malignancy. Int J Gynecol Cancer 27:1970–1978

    Article  Google Scholar 

  3. Wright JD, Lewin SN, Shah M et al (2011) Quality of venous thromboembolism prophylaxis in patients undergoing oncologic surgery. Ann Surg 253:1140–1146

    Article  Google Scholar 

  4. Pengo V, Lensing AW, Prins MH et al (2004) Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 350:2257–2264

    Article  CAS  Google Scholar 

  5. Prandoni P, Villalta S, Bagatella P et al (1997) The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients. Haematologica 82:423–428

    CAS  PubMed  Google Scholar 

  6. Grosse SD, Nelson RE, Nyarko KA, Richardson LC, Raskob GE (2016) The economic burden of incident venous thromboembolism in the United States: a review of estimated attributable healthcare costs. Thromb Res 137:3–10

    Article  CAS  Google Scholar 

  7. Walsh JJ, Bonnar J, Wright FW (1974) A study of pulmonary embolism and deep leg vein thrombosis after major gynaecological surgery using labelled fibrinogen-phlebography and lung scanning. J Obstet Gynaecol Br Commonw 81:311–316

    Article  CAS  Google Scholar 

  8. Horlander KT, Mannino DM, Leeper KV (2003) Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med 163:1711–1717

    Article  Google Scholar 

  9. Gould MK, Garcia DA, Wren SM et al (2012) Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e227S–e277

    Article  CAS  Google Scholar 

  10. Freeman AH, Barrie A, Lyon L et al (2016) Venous thromboembolism following minimally invasive surgery among women with endometrial cancer. Gynecol Oncol 142:267–272

    Article  Google Scholar 

  11. Graul A, Latif N, Zhang X et al (2017) Incidence of venous thromboembolism by type of gynecologic malignancy and surgical modality in the National Surgical Quality Improvement Program. Int J Gynecol Cancer 27:581–587

    Article  Google Scholar 

  12. Sandadi S, Lee S, Walter A et al (2012) Incidence of venous thromboembolism after minimally invasive surgery in patients with newly diagnosed endometrial cancer. Obstet Gynecol 120:1077–1083

    Article  Google Scholar 

  13. Bouchard-Fortier G, Geerts WH, Covens A, Vicus D, Kupets R, Gien LT (2014) Is venous thromboprophylaxis necessary in patients undergoing minimally invasive surgery for a gynecologic malignancy? Gynecol Oncol 134:228–232

    Article  Google Scholar 

  14. Premier Healthcare Database White Paper: Data that informs and performs (2018) Premier Applied Sciences®, Premier Inc. https://learn.premierinc.com/white-papers/premier-healthcaredatabase-whitepaper. Accessed 29 July 2018

  15. Wright JD, Ananth CV, Lewin SN et al (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309:689–698

    Article  CAS  Google Scholar 

  16. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ (2009) A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 47:626–633

    Article  Google Scholar 

  17. Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  Google Scholar 

  18. Laryea J, Champagne B (2013) Venous thromboembolism prophylaxis. Clin Colon Rectal Surg 26:153–159

    Article  Google Scholar 

  19. Committee on Practice Bulletins-Gynecology ACoO, Gynecologists (2007) ACOG Practice Bulletin No. 84: prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol 110:429–440

    Article  Google Scholar 

  20. Clarke-Pearson DL, Synan IS, Hinshaw WM, Coleman RE, Creasman WT (1984) Prevention of postoperative venous thromboembolism by external pneumatic calf compression in patients with gynecologic malignancy. Obstet Gynecol 63:92–98

    CAS  PubMed  Google Scholar 

  21. Clarke-Pearson DL, Abaid LN (2012) Prevention of venous thromboembolic events after gynecologic surgery. Obstet Gynecol 119:155–167

    Article  CAS  Google Scholar 

  22. Ritch JM, Kim JH, Lewin SN et al (2011) Venous thromboembolism and use of prophylaxis among women undergoing laparoscopic hysterectomy. Obstet Gynecol 117:1367–1374

    Article  Google Scholar 

  23. Amin AN, Lin J, Ryan A (2010) Need to improve thromboprophylaxis across the continuum of care for surgical patients. Adv Ther 27:81–93

    Article  Google Scholar 

  24. Amin AN, Stemkowski S, Lin J, Yang G (2009) Inpatient thromboprophylaxis use in US hospitals: adherence to the seventh American College of Chest Physician's recommendations for at-risk medical and surgical patients. J Hosp Med 4:E15–21

    Article  Google Scholar 

  25. Kakkar AK, Cohen AT, Tapson VF et al (2010) Venous thromboembolism risk and prophylaxis in the acute care hospital setting (ENDORSE survey): findings in surgical patients. Ann Surg 251:330–338

    Article  Google Scholar 

  26. Ageno W, Manfredi E, Dentali F et al (2007) The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study. J Thromb Haemost 5:503–506

    Article  CAS  Google Scholar 

  27. Feng L, Song J, Wong F, Xia E (2001) Incidence of deep venous thrombosis after gynaecological laparoscopy. Chin Med J (Engl) 114:632–635

    CAS  Google Scholar 

  28. Nick AM, Schmeler KM, Frumovitz MM et al (2010) Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery. Obstet Gynecol 116:956–961

    Article  Google Scholar 

  29. Kumar S, Al-Wahab Z, Sarangi S et al (2013) Risk of postoperative venous thromboembolism after minimally invasive surgery for endometrial and cervical cancer is low: a multi-institutional study. Gynecol Oncol 130:207–212

    Article  CAS  Google Scholar 

  30. Ramirez PT, Nick AM, Frumovitz M, Schmeler KM (2013) Venous thromboembolic events in minimally invasive gynecologic surgery. J Minim Invasive Gynecol 20:766–769

    Article  Google Scholar 

  31. Smith KB, Smith MS (2016) Obesity statistics. Prim Care 43(121–35):ix

    Google Scholar 

Download references

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY, 10032, USA

    Sbaa K. Syeda, Ling Chen, June Y. Hou, Ana I. Tergas, Fady Khoury-Collado, Alexander Melamed, Caryn M. St. Clair, Melissa K. Accordino, Alfred I. Neuget, Dawn L. Hershman & Jason D. Wright

  2. Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA

    Ana I. Tergas, Alfred I. Neuget & Dawn L. Hershman

  3. Herbert Irving Comprehensive Cancer Center, New York, NY, USA

    June Y. Hou, Ana I. Tergas, Fady Khoury-Collado, Alexander Melamed, Caryn M. St. Clair, Melissa K. Accordino, Alfred I. Neuget, Dawn L. Hershman & Jason D. Wright

  4. New York Presbyterian Hospital, New York, NY, USA

    Sbaa K. Syeda, June Y. Hou, Ana I. Tergas, Fady Khoury-Collado, Alexander Melamed, Caryn M. St. Clair, Melissa K. Accordino, Alfred I. Neuget, Dawn L. Hershman & Jason D. Wright

Authors
  1. Sbaa K. Syeda
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  2. Ling Chen
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Contributions

SKS: project development, data collection, data analysis, data interpretation, manuscript writing. LC: data collection, data analysis. JYH: data interpretation, manuscript editing. AIT: data interpretation, manuscript editing. FK-C: data interpretation, manuscript editing. AM: data interpretation, manuscript editing. CMSC: data interpretation, manuscript editing. MKA: data interpretation, manuscript editing. AIN: data interpretation, manuscript editing. DLH: data interpretation, manuscript editing. JDW: project development, data analysis, data interpretation, manuscript writing.

Corresponding author

Correspondence to Jason D. Wright.

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Conflict of interest

Dr. Wright has served as a consultant for Tesaro and Clovis Oncology and received research funding from Merck. Dr. Neugut has served as a consultant to Pfizer, Teva, Otsuka, Hospira, and United Biosource Corporation. He is on the scientific advisory board of EHE, Intl. No other authors have any conflicts of interest or disclosures.

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Syeda, S.K., Chen, L., Hou, J.Y. et al. Trends in venous thromboembolism prophylaxis in gynecologic surgery for benign and malignant indications. Arch Gynecol Obstet 302, 935–945 (2020). https://doi.org/10.1007/s00404-020-05678-0

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