Incidence, timing, severity, and predictors of venous thromboembolism after open abdominal wall reconstruction

Venous thromboembolic events, including deep vein thrombosis and pulmonary embolism, represent serious and potentially preventable complications following open abdominal wall reconstruction. This study aimed to determine the incidence and predictors of venous thromboembolic events after open abdominal wall reconstruction.

A single-institution prospectively maintained database was queried for open abdominal wall reconstruction (2010-2025). Standard statistical analyses and multivariable regression analyses were performed to identify predictors of venous thromboembolic events.

Among 2,907 open abdominal wall reconstructions, 49 venous thromboembolic events (1.7%) occurred: 31 pulmonary embolisms ± deep vein thrombosis and 18 deep vein thromboses alone. Average body mass index was 34.6 ± 10.0 kg/m², and 18.4% had prior venous thromboembolic events. Preoperative chemoprophylaxis was administered in 77.6% of venous thromboembolic event cases, and 93.8% of patients who received postoperative chemoprophylaxis had no interruption. Compared with patients without venous thromboembolic events, those with venous thromboembolic events had larger defect sizes (314.5 ± 222.7 vs 199.8 ± 187.5 cm²; P < .001) and longer operative times (233.4 ± 74.9 vs 187.2 ± 84.4 minutes; P < .001). Among 29 classified pulmonary embolisms, 13 were nonmassive, 12 submassive, and 4 massive/fatal. Advanced interventions were required in 12.2%, 16.3% required transfusion, and 16.3% underwent inferior vena cava filter placement. Among venous thromboembolic event patients, 40.8% required intensive care unit transfer, with 20.4% requiring reintubation. Average length of stay was longer in venous thromboembolic event patients (11.4 ± 9.8 vs 5.7 ± 8.8 days; P < .001). Multivariable regression identified body mass index (odds ratio, 1.09; 95% confidence interval, 1.04, 1.14; P < .001), prior venous thromboembolic events (odds ratio, 4.51; 95% confidence interval, 1.91, 10.62; P < .001), and operative time (odds ratio, 1.005; 95% confidence interval, 1.001, 1.010; P = .008) as independent predictors of venous thromboembolic event.

Postoperative venous thromboembolic event following open abdominal wall reconstruction is uncommon but associated with significant morbidity and mortality. Higher body mass index, prior venous thromboembolic event, and longer operative time independently predicted venous thromboembolic event, highlighting the need for improved risk stratification and prevention strategies.