Risk of Complications in Older Patients Receiving Single-Dose Pharmacologic Thromboprophylaxis Prior to Prolapse...

Older women pursuing surgical management of pelvic organ prolapse are often at high risk for venous thromboembolism (VTE), yet administration of preoperative pharmacologic thromboprophylaxis (PTX) may increase risk of wound complications and bleeding. We sought to determine the association between PTX and bleeding or wound complications in older women at elevated risk for VTE undergoing prolapse surgery.

Retrospective cohort study.

Two academic medical centers.

Women ≥61 years of age at elevated risk for VTE by the Caprini risk assessment model (score ≥5) undergoing prolapse surgery from January 2016 to May 2023.

Single preoperative dose of PTX (subcutaneous unfractionated or low-molecular weight heparin before incision).

The primary outcome was a composite wound and bleeding adverse event, which included estimated blood loss ≥500 mL, surgical site infection, wound dehiscence, transfusion, and hematoma within 8 weeks post-surgery. Of 2,761 older patients undergoing prolapse surgery, 2,279 (82.5%) had a Caprini score ≥5. Of these, 808 (35.5%) received PTX. PTX was associated with higher body mass index (BMI), history of cancer, prior VTE, stroke, and chronic anticoagulant use. Patients who received PTX were more likely to undergo laparoscopic or robotic approach (37.3% vs 25.1%, p <.01), concomitant hysterectomy (48.0% vs 42.5%, p = .01), general anesthesia (98.0% vs 93.9%, p <.01), and same-day discharge (80.8% vs 70.3%, p <.01). The incidence of bleeding and wound complications was 5.1%, and the incidence of VTE was 0.5%. On multivariable analysis, there was no association between PTX and bleeding and wound complications (adjusted OR 1.29, 95% CI 0.87-1.90).

PTX administration in older women with Caprini score of ≥5 undergoing reconstructive pelvic surgery was not associated with increased bleeding and wound complications, which supports its use in benign gynecologic patients at risk for VTE.