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Incidence and Predictors of Venous Thromboembolism After Debulking Surgery for Epithelial Ovarian Cancer
  1. Bahareh Mokri, MD*,
  2. Andrea Mariani, MD*,
  3. John A. Heit, MD,
  4. Amy L. Weaver, MS,
  5. Michaela E. McGree, BS,
  6. Janice R. Martin, RN§,
  7. Maureen A. Lemens, RN, BSN§,
  8. William A. Cliby, MD* and
  9. Jamie N. Bakkum-Gamez, MD*
  1. *Division of Gynecologic Surgery, Department of Obstetrics and Gynecology,
  2. Division of Cardiovascular Diseases, Department of Medicine,
  3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and
  4. §Department of Surgery, Mayo Clinic, Rochester, MN.
  1. Address correspondence and reprint requests to Jamie N. Bakkum-Gamez, MD, Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Eisenberg Lobby 71, Mayo Clinic, 200 First St, SW, Rochester, MN 55905. E-mail: Bakkum.jamie{at}mayo.edu.

Abstract

Objective The aim of this study was to determine the incidence and the risk factors of venous thromboembolism (VTE) within 30 days after primary surgery for epithelial ovarian cancer (EOC).

Methods In a historical cohort study, we estimated the postoperative 30-day cumulative incidence of VTE among consecutive Mayo Clinic patients undergoing primary cytoreduction for EOC between January 2, 2003, and December 29, 2008. We tested perioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program, >130 variables) as potential predictors of postoperative VTE using the Cox proportional hazards modeling.

Results Among 569 cases of primary EOC cytoreduction and/or staging and no recent VTE, 35 developed symptomatic VTE within 30 days after surgery (cumulative incidence = 6.5%; 95% confidence interval, 4.4%–8.6%). Within the cohort, 95 (16.7%) received graduated compression stockings (GCSs), 367 (64.5%) had sequential compression devices + GCSs, and 69 (12.1%) had sequential compression devices + GCSs + postoperative heparin, with VTE rates of 1.1%, 7.4%, and 5.8%, respectively (P = 0.07, χ2 test). The remaining 38 (6.7%) received various other chemical and mechanical prophylaxis regimens. In the multivariate analysis, current or past tobacco smoking, longer hospital stay, and a remote history of VTE significantly increased the risk for postoperative VTE.

Conclusions Venous thromboembolism is a substantial postoperative complication among women with EOC, and the high cumulative rate of VTE within 30 days after primary surgery suggests that a more aggressive strategy is needed for VTE prevention. In addition, because longer hospital stay is independently associated with a higher risk for VTE, methods to decrease length of stay and minimize factors that contribute to prolonged hospitalization are warranted.

  • Venous thromboembolism
  • Deep vein thrombosis
  • Ovarian cancer
  • Surgery

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Footnotes

  • Funded, in part, by the Office of Women’s Health Research Building Interdisciplinary Careers in Women’s Health (BIRCWH award K12 HD065987).

  • The funding source played no role in the design, conduct, or reporting of this study.

  • The authors declare no conflicts of interest.

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