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Symptomatic venous thromboembolism in Chinese patients after gynecologic surgery: incidence and disease pattern
Louis Yik Si Chan1, Pong Mo Yuen, Wing Kit Lo
1Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. lyschan@netvigator.com
Insights
Thromboembolic disease is not rare in Chinese women after gynecologic surgery, challenging previous beliefs. This study found an incidence similar to Caucasian populations, suggesting under-diagnosis contributed to the misconception.
Area of Science:
- Obstetrics and Gynecology
- Vascular Surgery
- Epidemiology
Background:
- Venous thromboembolism (VTE) is a significant cause of postoperative morbidity and mortality in Caucasian populations.
- It is commonly believed that VTE is rare in Chinese populations.
Purpose of the Study:
- To investigate the incidence and characteristics of thromboembolic disease in Chinese women undergoing gynecologic surgery.
- To challenge the prevailing notion of VTE rarity in this demographic.
Main Methods:
- A retrospective study was conducted from January 1998 to December 2000.
- Medical records of women diagnosed with thromboembolic disease after gynecologic surgery were reviewed.
Main Results:
- Thirty-one cases of thromboembolic disease were identified in 6077 gynecologic surgeries, yielding an overall incidence of 5.10 per 1000 operations.
- Deep vein thrombosis was most common (90% in calf veins), with two cases of pulmonary embolism.
- Incidence increased significantly in 1999-2000 compared to 1998, following a maternal death from pulmonary embolism.
Conclusions:
- Thromboembolic disease is not uncommon in Chinese women after gynecologic surgery.
- The incidence appears similar to Caucasian populations, though with differing vascular occlusion sites.
- Under-diagnosis may explain the historical belief in the rarity of VTE among Chinese patients.
Background:
Venous thromboembolism is a common cause of postoperative morbidity and mortality in Caucasian populations, but it is widely believed that this complication is rare in Chinese.
Methods:
We conducted a retrospective study from January 1998 to December 2000. Women with thromboembolic diseases after gynecologic surgery were identified and their medical records were reviewed.
Results:
During the study period, thirty-one women were diagnosed as having thromboembolic disease after gynecologic surgery. Over the study period, the total number of operations was 6077, giving an incidence of 5.10/1000 operations. There were two cases of pulmonary embolism and the others had deep vein thrombosis of which 90% were limited to calf veins only. The incidences were significantly higher in 1999 and 2000 (7.59 and 6.85/1000 operations, respectively) than that in 1998 (1.7/1000 operations) (P = 0.015), after a case of maternal death due to pulmonary embolism in early 1999. Most cases of thromboembolism were diagnosed after major surgery for malignancy (n = 14) or benign conditions (n = 12). In the remaining cases, three had evacuation of the uterus for retained products of conception and two had laparoscopy for suspected ectopic pregnancies.
Conclusions:
Thromboembolic disease is not uncommon among Chinese women after gynecologic surgery. The incidence is similar to that of the Caucasian population, although the sites of vascular occlusion were different. The long belief that thromboembolism is rare among Chinese is at least partly due to under-diagnosis.