Venous thromboembolism after ventral hernia repair with transversus abdominis release

Venous thromboembolism (VTE) events, such as pulmonary embolism (PE) and deep venous thrombosis (DVT), are a significant source of morbidity and mortality after major abdominal wall reconstruction. We aim to describe the incidence of VTE events in patients undergoing ventral hernia repair (VHR) with transversus abdominis release (TAR) at our institution.

The Abdominal Core Health Quality Collaborative registry was queried for patients, 18 years and older, who underwent VHR with TAR at our institution between August 2014 and December 2023. Patient characteristics and operative details were obtained from the registry. Patient electronic medical records were reviewed for outcomes. The primary study outcome was the incidence of VTE, including PE and DVT, within 8 weeks postoperatively. Secondary outcomes included time to VTE, VTE chemoprophylaxis protocol used, VTE management, and complications.

Of the 3555 patients who underwent abdominal wall reconstruction and met inclusion criteria, 100 patients experienced (2.8%) VTE events; 58 patients had a PE and 42 had DVTs. The median time to a VTE event was 7 (IQR 4-14) days after surgery, and 27% of VTE events occurred after hospital discharge. Of the patients who experienced a VTE event, 77 received preoperative chemoprophylaxis and 66 patients received postoperative chemoprophylaxis beginning on the day of surgery. In 19 patients, chemoprophylaxis was interrupted prior to development of VTE. Most patients (n = 88) were managed with systemic anticoagulation, and 18.1% had a bleeding complication related to anticoagulation treatment.

Patients undergoing major abdominal wall reconstruction are at high risk for venous thromboembolism events, even after hospital discharge. Further studies are needed to determine risk factors associated with VTE in this specific patient population to optimize perioperative anticoagulation strategies.