Effect of Surgical Subspecialty on Time to Development of Postoperative Venous Thromboembolism
Insiyah Campwala, Liling Lu, Pooja Humar, Maryanna Owoc, Caroline Kettering, Kathleen Marie Inman Fuentes, Adnan Hassoune, Jurgis Alvikas, Elizabeth Andraska, Sara P Myers, Robert Handzel, Matthew D NealBackground:
Postoperative venous thromboembolism (VTE) remains a major cause of surgical morbidity despite guideline-based prophylaxis. Whether VTE timing and thromboprophylaxis patterns differ across surgical subspecialties is incompletely characterized.
Study Design:
Retrospective cohort study of adults with imaging-confirmed postoperative VTE during the index admission within a multihospital healthcare system (2013–2019). VTE events were identified using natural language processing and confirmed by chart review. Primary outcome was time to postoperative VTE; secondary outcome was time to thromboprophylaxis. Kaplan-Meier analyses and multivariable Cox proportional hazards models evaluated associations across surgical specialties.
Results:
Among 1,520 patients with postoperative VTE, 24.9% had deep vein thrombosis (DVT) only, 67.2% pulmonary embolism (PE) only, and 7.9% both. Median time to VTE was 4 days (IQR 2.0–8.0); PE occurred earlier than DVT (3 vs 6 days; p<0.001). Neurosurgery had the highest VTE incidence (0.23% of neurosurgical cases), whereas orthopedic surgery demonstrated the highest adjusted hazard for postoperative VTE. Overall, 76% received postoperative thromboprophylaxis beginning a median of 1.3 days after surgery (IQR 0.8–1.7). Patients without thromboprophylaxis developed VTE earlier than those receiving prophylaxis (2.0 vs 4.0 days; p<0.001). Cardiac surgery demonstrated the lowest adjusted likelihood of thromboprophylaxis, whereas thoracic surgery had the highest (HR 5.8, 95% CI 2.8–12.1; reference cardiac), and trauma patients were less likely to receive prophylaxis (HR 0.44, 95% CI 0.34–0.57).
Conclusions:
Postoperative VTE risk, timing, and thromboprophylaxis practices vary substantially across surgical subspecialties. These findings support specialty-specific VTE risk assessment, prophylaxis strategies, and postoperative surveillance.