Postoperative venous thromboembolism risk following lung cancer surgery: a systematic review and meta-analysis

Venous thromboembolism (VTE) remains a major contributor to postoperative morbidity and mortality in patients undergoing lung cancer surgery. This study aims to identify perioperative risk factors associated with VTE development following such procedures. We performed an exhaustive search of PUBMED and EMBASE from inception to November 1, 2023, using terms related to VTE following lung cancer surgery. A random-effects meta-analysis was performed to calculate the pooled incidence and odds ratios (ORs) for risk factors. Of 3,576 screened studies, 13 met eligibility criteria for qualitative synthesis, and 11 studies (53,382 patients) were included in the meta-analysis. The pooled incidence of postoperative VTE was 1.82% (971 cases). Significant risk factors included advanced age (standardized mean difference [SMD] 0.43, 95% CI 0.22-0.63; I² = 59.9%), prolonged surgical duration (SMD 0.58, 95% CI 0.24-0.92; I² = 81.2%), open thoracotomy (OR 1.77, 95% CI 1.50-2.09; I² = 19.9%), TNM stage > 1 (OR = 1.81, 95% CI 1.53-2.13; I² = 39.8%), adenocarcinoma histology (OR = 1.29, 95% CI 1.08-1.53; I² = 1.2%), and major lung resection (OR = 1.51, 95% CI 1.24-1.83; I2 = 0.0%). This study highlights key modifiable and non-modifiable risk factors for postoperative VTE in lung cancer surgery patients. These findings support individualized risk stratification and targeted thromboprophylaxis strategies to improve clinical outcomes.