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Venous thromboembolism after laparotomic and laparoscopic myomectomy with large myoma burden
Mateo G Leon1, Jorge Cervantes2, Aakriti R Carrubba1
1Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida.
Study Objective:
To investigate the incidence of venous thromboembolism (VTE) in patients undergoing myomectomy. To evaluate the impact of route of surgery, myoma burden, and operative time in the development of VTE in this population.
Design:
Retrospective cohort study (Canadian Task Force Classification II2) of targeted myomectomy data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) SETTING: NSQIP Database PATIENTS OR PARTICIPANTS: Women aged ≥18 years undergoing laparotomic and laparoscopic myomectomy between 2011 and 2022. Patients were classified by Current Procedural Terminology (CPT) codes as having low or high myoma burden (>250 g or >4 fibroids). Patients undergoing hysterectomy, vaginal or hysteroscopic myomectomy, with malignant pathology, or missing operative time were excluded.
Interventions:
Cases were identified by CPT codes. Variables including age, ethnicity, body mass index (BMI), smoking status, diabetes, hypertension, blood transfusion, inpatient status, and American Society of Anesthesiologists classification system scores were collected. Clinical predictors of VTE were evaluated by stratifying cases according to surgical route, operative time, year of procedure, and myoma burden.
Measurements And Main Results:
A total of 38,167 myomectomies occurring between 2011-2022 were included. Of these, 20,943 (54.9%) patients underwent laparotomy, and 17,224 (45.1%) patients underwent laparoscopy. The incidence of VTE after myomectomy was 0.28%. Patients undergoing laparotomy had twice the VTE rate (0.36%) compared with those undergoing laparoscopy (0.18%). Patients undergoing laparotomy were more likely to be younger, of non-Hispanic African American ethnicity, inpatient, with higher BMI, require blood transfusion, have higher myoma burden, and have shorter operative times. After multivariable adjustment, neither myoma burden nor surgical route was independently associated with VTE. However, longer operative time (>186 min, 75 percentile) was independently associated with increased odds of VTE (aOR 2.73; CI:1.52-4.90).
Conclusion:
The occurrence of VTE after laparoscopic and laparotomic myomectomy is uncommon. The rate of VTE is higher with longer operative times, but this outcome is not significantly associated with surgical route or myoma burden.
