Perioperative venous thromboembolism risk in patients undergoing hysterectomy for fibroids: a U.S. retrospective cohort study.

OBJECTIVE: Venous thromboembolism (VTE) occurs in 0.4-0.7% of benign hysterectomies. Pelvic vascular compression secondary to fibroids may elevate VTE risk. We aimed to evaluate the incidence and timing of VTE among individuals undergoing hysterectomy for fibroids and other benign indications.

METHODS: Retrospective cohort study of patients who underwent a hysterectomy for fibroid and non-fibroid indications from January 2015 to December 2021. Main outcome measure was VTE consisting of pulmonary embolism or deep venous thrombosis diagnosed during 3 periods: i) preoperative (1 year before surgery until day before surgery), ii) early postoperative (surgery date through 6 weeks after surgery), and iii) late postoperative (6 weeks to 1 year after surgery). Demographics, comorbidities, surgical characteristics, and VTE rates were compared by indication.

RESULTS: 263 844 individuals with fibroids and 203 183 without were identified. 1.1% experienced VTE. On multivariable regression (adjusted demographic confounders and route of surgery), the presence of fibroids was associated with increased odds of preoperative (aOR 1.12, 95% CI 1.03-1.22, P = 0.011) and reduced odds of late postoperative VTE (aOR 0.81, 95% CI 0.73-0.91, P < 0.001). For individuals with fibroids, uterine weight ≥250 g and undergoing laparotomy were independently associated with preoperative (aOR 1.29, 95% CI 1.09-1.52, P = 0.003 and aOR 2.32, 95% CI 2.10-2.56, P < 0.001) and early postoperative VTE (aOR 1.32, 95% CI 1.08-1.62, P = 0.006 and aOR 1.72, 95% CI 1.50-1.96, P < 0.001).

CONCLUSION: Patients with fibroids were at increased odds of having VTE 1 year before hysterectomy. For those with fibroids, elevated uterine weight and laparotomy were associated with greater risk of preoperative and early postoperative VTEs.