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Surgery increases VTE risk for middle-aged women
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A recent prospective cohort study shows that middle-aged women who underwent in-patient surgical procedures were 70 times more likely to be re-admitted for venous thromboembolism for up to 6 weeks postoperatively than women who did not have surgery.
The research published in the British Medical Journal also indicated that women who underwent same-day surgery had a 10-times greater risk of admission for a venous thromboembolism (VTE) compared to women who did not have surgery.
Long-lasting risk
To study the risk of VTE in middle-aged women, Sian Sweetland, PhD, a statistical epidemiologist at the University of Oxford, and colleagues linked questionnaire data from 947,454 women in the United Kingdom who were enrolled in the Million Women Study between 1996 and 2001 with hospital admission and death records.
Among them, the researchers identified 239,614 women who were admitted for surgery. Of these 5,419 women were admitted for a VTE and 270 of them died from it.
The researchers also noted that the VTE risk was still slightly elevated 7 to 12 weeks after surgery. Many patients also remained at-risk for at least 1 year postoperatively, according to a press release from the British Medical Journal. In addition, the researchers found that risk varied by type of surgery. They found the highest risks for VTE following in-patient surgery for hip or knee replacement, cancer and fractures.
Conclusions, commentary
“An estimated 1 in 140 middle-aged women undergoing in-patient surgery in the U.K. will be admitted with VTE during the 12 weeks after surgery [including] 1 in 45 after hip or knee replacement and 1 in 85 after surgery for cancer, compared with 1 in 815 after day case surgery and only 1 in 6, 2,000, women during a 12 week period without surgery,” the investigators wrote in their abstract.
Alexander Cohen, a vascular surgeon at King’s College Hospital in London, stated in an accompanying editorial that Sweetland’s study broadens the understanding of the short-term risks for VTE in certain types of surgery, particularly for same-day surgery.
Since many VTEs are undiagnosed, untreated or managed out of the hospital, the rates identified in Sweetland’s study may be lower than the true values for the event, Cohen noted.
The findings emphasize the need to further study the rate of VTE, use of preventive anti-clotting therapy and extending therapy for longer than 5 weeks in most surgical patients, Cohen noted.
- Reference:
Cohen AT. Prevention of postoperative venous thromboembolism. BMJ 2009;339: b4477-b4477.
Sweetland S, Green J, Liu B, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ. 2009;339: b4583.