Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacological prophylaxis is effective in reducing the incidence of this complication but is often discontinued at the time of hospital discharge, especially for those with benign diseases. The implications of this practice are not known.
To assess data from a large, ongoing registry regarding the time course of VTE and outcomes after non-cancer surgery.
We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes consecutive patients with symptomatic confirmed VTE. This study focuses on general surgical patients who developed symptomatic postoperative VTE in the first 8 weeks after non-cancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavourable outcomes.
A total of 3,296 patients were analysed. Median time from surgery to detection of VTE was 16 days (IQR: 8-30). Seventy-seven percent of the events were detected after the first postoperative week, and another 27% after 4 weeks. Overall, 43.9% of the patients with VTE received pharmacological prophylaxis after surgery, for a median of eight days (IQR: 5-14), and three quarters of the VTE events were detected despite pharmacological prophylaxis was discontinued. Overall, 54% of patients with VTE presented with pulmonary embolism. In 15% of patients the clinical outcome was unfavourable, including 4% who died within 90 days.
The risk of VTE after non-cancer general surgery remains high for up to 2 months. More than half of the patients presented VTE as symptomatic PE, and 15% had unfavourable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around one week.

Copyright © 2020. Published by Elsevier Inc.

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