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Risk of Thromboembolic Disease in Patients Undergoing Laparoscopic Gynecologic Surgery

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Abstract

OBJECTIVE:

To estimate the incidence of venous thromboembolism among patients undergoing gynecologic laparoscopy and characterize the risk of venous thromboembolism among patients with gynecologic malignancy.

METHODS:

Data were collected for patients who underwent laparoscopic gynecologic surgery from January 2000 to January 2009. Incidence of deep vein thrombosis (DVT) or pulmonary embolism diagnosed within 6 weeks of surgery was estimated. Fisher's exact test was used to estimate the association between the presence of perioperative venous thromboembolism and categorical variables.

RESULTS:

Six (of 849) patients developed symptomatic venous thromboembolism (0.7%, 95% confidence interval: 0.024–1.44%). The median time to diagnosis of venous thromboembolism was postoperative day 15.5 (range, 1–41 days), median body mass index was 25.4 kg/m2 (range, 18.4–50 kg/m2), median operative time was 176 minutes (range, 53–358 minutes), and median estimated blood loss was 125 mL (range, 10–250 mL). Five of 430 (1.2%) patients with a history of gynecologic malignancy developed postoperative thromboembolic events. Venous thromboembolism was diagnosed in three of 662 (0.5%) patients undergoing intermediate complexity procedures and three of 106 (2.8%) patients undergoing high-complexity procedures. Three patients with venous thromboembolism (50%) had a history of at least one previous modality of cancer treatment before laparoscopy. One patient (17%) had DVT only, four (67%) had pulmonary emboli without an identified DVT, and one (17%) had both. There were no associated mortalities.

CONCLUSION:

The incidence of thromboembolism in patients undergoing low- and intermediate-complexity, minimally invasive surgery was low, even among patients with a gynecologic malignancy. Patients undergoing high-complexity, minimally invasive procedures may benefit from postoperative anticoagulation.

LEVEL OF EVIDENCE:

II

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