title: Risk of venous thromboembolism in patients undergoing surgery for pelvic organ prolapse.
abstract: OBJECTIVE
  We sought to determine the incidence of venous thromboembolism (VTE) in patients undergoing surgery for pelvic organ prolapse (POP) based on surgical approach.
  
  
  METHODS
  The American College of Surgeons National Quality Improvement Program (NSQIP) database was used to select all surgeries performed for POP from 2005 to 2013. CPT-4 codes were grouped based on surgical approach: vaginal (VAG), laparoscopic sacrocolpopexy (LSC), or open abdominal sacrocolpopexy (ASC). Patient demographics, preoperative American Society of Anesthesiologists (ASA) classification system scores, and 30-day postoperative complications were obtained.
  
  
  RESULTS
  Of the 26,103 women who underwent surgery for POP, 21,311 (81.7 %) underwent VAG, 3,346 (12.8 %) LSC, and 1,426 (5.5 %) ASC. VTE occurred in 36 patients (0.17 %) in the VAG group, 8 (0.24 %) in the LSC group, and 9 (0.63 %) in the ASC group. The ASC group had a significantly higher incidence of VTE compared with the VAG group (p < 0.01). Upon multivariate analysis, factors associated with a greater incidence of VTE included BMI greater than 30 kg/m(2) (p = 0.048), ASA score of 3, 4, or 5 (p = 0.027), and length of stay above the 75th percentile (p < 0.01). The procedure group did not retain statistical significance in multivariate modeling.
  
  
  CONCLUSIONS
  Venous thromboembolism is rare following surgery for POP. Although differences in VTE rates between procedure groups failed to maintain statistical significance after multivariate analysis, we were able to identify risk factors associated with an increased VTE risk in surgery for POP. Women with obesity, an increased length of stay, or ASA score of 3 or higher are at an increased risk for developing VTE after undergoing surgery for POP.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA. Hokenstad.erik@mayo.edu.|Division of Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. Hokenstad.erik@mayo.edu.
authors.forename: Erik D
authors.identifier: http://orcid.org/0000-0003-3152-5355
authors.initials: ED
authors.lastname: Hokenstad
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Glasgow
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Occhino
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012306:Risk; D012307:Risk Factors; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014621:Vagina / Q000601:surgery*; D054556:Venous Thromboembolism / Q000453:epidemiology*
keywords: Pelvic organ prolapse; Surgical complications; Venous thromboembolism