Association of Prophylaxis and Length of Stay With Venous Thromboembolism in Abdominopelvic Surgery

Published:October 29, 2022DOI:



      Extended venous thromboembolism prophylaxis (eVTEp) is recommended for select patients who have undergone major abdominopelvic surgery to prevent postdischarge venous thromboembolism (pdVTE). Criteria for selection of these patients are untested for this purpose and may be ineffective. To address this gap, we investigated the effectiveness of eVTEp on pdVTE rates.


      A retrospective cohort study of patients undergoing abdominopelvic surgery from January 2016 to February 2020 was performed using data from the Michigan Surgical Quality Collaborative. pdVTE was the main outcome. Our exposure variable, eVTEp, was compared dichotomously. Length of stay (LOS) was compared categorically using clinically relevant groups. Age, race, cancer occurrence, inflammatory bowel disease, surgical approach, and surgical time were covariates among other variables. Descriptive statistics, propensity score matching, and multivariable logistic regression were performed to compare pdVTE rates.


      A total of 45,637 patients underwent abdominopelvic surgery. Of which, 3063 (6.71%) were prescribed eVTEp. Two hundred eighty-five (0.62%) had pdVTE. Of the 285, 59 (21%) patients received eVTEp, while 226 (79%) patients did not. After propensity score matching, multivariable logistic regression analysis showed pdVTE was associated with eVTEp and LOS of 5 d or more (P < 0.001). eVTEp was not associated with LOS. Further analysis showed increased risk of pdVTE with increasing LOS independent of prescription of eVTEp based on known risk factors.


      pdVTE was associated with increasing LOS but not with other VTE risk factors after propensity score matching. Current guidelines for eVTEp do not include LOS. Our findings suggest that LOS >5 d should be added to the criteria for eVTEp.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Heit J.A.
        “Venous thromboembolism: disease burden, outcomes and risk factors.”.
        J Thromb Haemost. 2005; 3: 1611-1617
        • Moghadamyeghaneh Z.
        • Alizadeh R.F.
        • Hanna M.H.
        • et al.
        Post-hospital discharge venous thromboembolism in colorectal surgery.
        World J Surg. 2016; 40: 1255-1263
        • Anderson Jr., F.A.
        • Zayaruzny M.
        • Heit J.A.
        • et al.
        Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism.
        Am J Hematol. 2007; 82: 777-782
        • Barkoudah E.
        • Piazza G.
        • Hecht T.
        • et al.
        “Extended venous thromboembolism prophylaxis in medically ill patients: an Natf anticoagulation action initiative.”.
        Am J Med. 2020; 133: 1-27
        • Merkow R.P.
        • Bilimoria K.Y.
        • McCarter M.D.
        • et al.
        “Post-discharge venous thromboembolism after cancer surgery.”.
        Ann Surg. 2011; 254: 131-137
        • Beal E.W.
        • Tumin D.
        • Chakedis J.
        • et al.
        “Identification of patients at high risk for post-discharge venous thromboembolism after Hepato-Pancreato-biliary surgery: which patients benefit from extended thromboprophylaxis?”.
        HPB. 2018; 20: 621-630
        • Tzeng C.D.
        • Katz M.H.G.
        • Lee J.E.
        • et al.
        “Predicting the risks of venous thromboembolism versus post-pancreatectomy haemorrhage: analysis of 13771 NSQIP patients.”.
        HPB. 2014; 16: 373-383
        • Kim N.E.
        • Conway-Pearson L.
        • Kavanah M.
        • et al.
        “Standardized risk assessment and risk-stratified venous thromboembolism prophylaxis for patients undergoing breast operation.”.
        J Am Coll Surgeons. 2019; 230: 947-955
        • Heit J.A.
        • Crusan D.J.
        • Ashrani A.A.
        • et al.
        Effect of a near-universal hospitalization-based prophylaxis regimen on annual number of venous thromboembolism events in the US.
        Blood. 2017; 130: 109-114
        • Gould M.K.
        • Garcia D.A.
        • Wren S.M.
        • et al.
        “Prevention of VTE in non-orthopedic surgical patients.”.
        Chest. 2012; 141: e227S-e277S
        • Farge D.
        • Frere C.
        • Connors J.M.
        • et al.
        “2019 international clinical practice guidelines for the treatment of and prophylaxis of venous thromboembolism in patients with cancer.”.
        Lancet Oncol. 2019; 20: e566-e581
        • Pannucci C.J.
        • Laird S.
        • Dimick J.B.
        • et al.
        “A validated risk model to predict 90-day VTE events in postsurgical patients.”.
        Chest. 2014; 145: 567-573
        • Swenson C.W.
        • Berger M.B.
        • Kamdar N.S.
        • et al.
        “Risk factors for venous thromboembolism after hysterectomy.”.
        Obstet Gynecol. 2015; 125: 1139-1144
        • Gangireddy C.
        • Rectenwald J.R.
        • Upchurch G.R.
        • et al.
        “Risk factors and clinical impact of postoperative symptomatic venous thromboembolism.”.
        J Vasc Surg. 2007; 45: 335-341
        • Cronin M.
        • Dengler N.
        • Krauss E.S.
        • et al.
        Completion of the updated caprini risk assessment model (2013 version).
        Clin Appl Thromb Hemost. 2019; 25 (1076029619838052)
        • Geerts W.H.
        • Bergqvist D.
        • Pineo G.F.
        • et al.
        Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th edition).
        Chest. 2008; 133: 381S-453S
        • Schünemann H.J.
        • Cushman M.
        • Burnett A.E.
        • et al.
        American society of hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients.
        Blood Adv. 2018; 2: 3198-3225
        • Nikolian V.C.
        • Regenbogen S.E.
        Statewide clinic registries: the Michigan surgical quality collaborative.
        Clin Colon Rectal Surg. 2019; 32: 16-24
        • De Martino R.R.
        • Goodney P.P.
        • Spangler E.L.
        • et al.
        “Variation in thromboembolic complications among patients undergoing commonly performed cancer operations”.
        J Vasc Surg. 2012; 55: 1035-1040.e4
        • Amin A.
        • Neuman W.R.
        • Lingohr-Smith M.
        • Menges B.
        • Lin J.
        Influence of the duration of hospital length of stay on frequency of prophylaxis and risk for venous thromboembolism among patients hospitalized for acute medical illnesses in the USA.
        Drugs Context. 2019; 8: 212568
        • Carbajal-Mamani S.L.
        • Dideban B.
        • Schweer D.
        • et al.
        Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis?.
        J Robotic Surg. 2020; 15: 343-348
        • Heijkoop B.
        • Nadi S.
        • Spernat D.
        • Kiroff G.
        Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety.
        Perioper Med (Lond). 2020; 9: 7
        • Agnelli G.
        • Bolis G.
        • Capussotti L.
        • et al.
        “A clinical outcome-based prospective study on venous thromboembolism after cancer surgery”.
        Ann Surg. 2006; 243: 89-95
        • Hanna-Sawires R.G.
        • Groen J.V.
        • Klok F.A.
        • et al.
        “Outcomes following pancreatic surgery using three different thromboprophylaxis regimens”.
        Br J Surg. 2019; 106: 765-773
        • Sutzko D.C.
        • Obi A.T.
        • Kamdar N.
        • et al.
        “Low to moderate risk non-orthopedic surgical patients do not benefit from VTE chemoprophylaxis.”.
        Ann Surg. 2020; ([e-pub ahead of print])
        • Ruff S.M.
        • Ayabe R.I.
        • Wach M.M.
        • et al.
        “Practice patterns of VTE chemoprophylaxis after discharge following hepatic and pancreatic resections for cancer: a survey of hepatopancreatobiliary surgeons.”.
        J Thromb Thrombolysis. 2019; 48: 119-124
        • National Comprehensive Cancer Network
        Cancer-associated venous thromboembolic disease (version 1.2017).
        (Available at:)