Venous thromboembolism after surgery for chronic pancreatitis: is extended postoperative chemoprophylaxis warranted?

Surgery for pancreatic cancer is associated with postoperative venous thromboembolism (VTE) rates of 5% to 20%, prompting the routine use of extended VTE chemoprophylaxis. The incidence and predictors of VTE after chronic pancreatitis (CP) surgery remain unclear.

Retrospective single-institution analysis of postsurgical patients for CP between January 2007 and June 2025. Postoperative VTE rates at 90 days were evaluated, including extremity deep vein thrombosis (DVT), pulmonary embolism (PE), and mesenteric vein thrombosis (MVT). Perioperative definitions aligned with the American College of Surgeons National Surgical Quality Improvement Program and the International Study Group for Pancreatic Surgery.

A total of 739 patients underwent surgery for CP. Venous thrombosis developed in 50 (6.8%) patients. Postoperative DVT/PE was diagnosed in 22 (3.0%) patients on postoperative day 23 ± 20. Multivariable regression found higher body mass index, lower serum albumin, and longer operative time to be risk factors for DVT/PE. Major morbidity was higher in patients who developed DVT/PE (86.3% vs 40.2%; P <.001); however, mortality was similar between groups (0% vs 0.6%; P =.7). Postoperative MVT was diagnosed in 33 (4.5%) patients on postoperative day 23±18. Multivariable regression found organ-space infection and postpancreatectomy hemorrhage to be risk factors for MVT. Major morbidity (81.8% vs 39.7%; P <.001) and mortality (6.1% vs 0.4%; P =.0001) were higher in patients who developed MVT.

Extremity DVT, PE, and/or MVT occurred in 6.8% of patients who underwent surgery for CP and impacted postoperative morbidity and mortality. Given this high-risk population, prospective studies optimizing strategies for postoperative chemoprophylaxis are warranted and should consider extended chemoprophylaxis and weight-based dosing.