Mark Crowther, MD, MSc
In middle-aged women, what is the risk for postoperative venous thromboembolism (VTE) by time since surgery and type of surgery?
Prospective cohort study (Million Women Study).
Population-based study in the UK.
947 454 of 1.3 million middle-aged women in the Million Women Study (mean age 56 y) who had no history of blood clot or treatment for clotting problems, cancer, or hospitalization for VTE. Women with surgery in the year before enrollment or > 1 operation during follow-up were also excluded.
Inpatient or day-case hospitalization for a surgical procedure.
First hospitalization for or death from pulmonary embolism or deep venous thrombosis.
Relative risk (RR) for VTE (compared with women who did not have surgery) was greater for women having inpatient surgery than for those having day-case surgery and varied by time since surgery (Table). Risk was highest in the first 6 weeks after inpatient surgery, reaching a peak in the third week, but remained elevated up to 12 months after surgery. Risk for VTE in the first 6 weeks after inpatient surgery was greatest in women having joint replacement (RR 221, 95% CI 188 to 259) and was substantially increased after surgery for cancer (RR 92, CI 74 to 113), fracture (RR 89, CI 66 to 121), and vascular conditions (RR 87, CI 67 to 113). After 6 weeks, risk was highest in women having cancer surgery. Day-case cancer surgery was also associated with high risk for VTE up to 1 year after surgery.
In middle-aged women, risk for postoperative venous thromboembolism varied by time since surgery and type of surgery, remaining substantially increased for ≥ 12 weeks for most types of surgery. Joint replacement surgery and cancer surgery had the highest risks, and duration of risk was longest with cancer surgery.
Risk for venous thromboembolism (VTE) after inpatient or day-case surgery in middle-aged women
*CI defined in Glossary. Relative risk compared with women who did not have surgery.
Crowther M. Risk for postoperative venous thromboembolism in women was increased for ≥ 12 weeks and varied by type of surgery. Ann Intern Med. ;152:JC3–11. doi: 10.7326/0003-4819-152-6-201003160-02011
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Published: Ann Intern Med. 2010;152(6):JC3-11.
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