Perioperative Management and Outcomes of Preoperatively Diagnosed Venous Thromboembolism in Gynecological Surgery: A Multicenter Retrospective Study Based on 2020–2022 Data From the Japanese Society of Anesthesiologists

Abstract

Aim

Patients with preoperatively diagnosed venous thromboembolism (VTE) present complex management challenges, and optimal strategies for gynecological surgery remain unclear. Because malignancy is a major risk factor for VTE, perioperative management and outcomes may differ between malignant and benign gynecological diseases. This study aimed to compare perioperative management and short-term outcomes between these groups.

Methods

This retrospective observational study included 1406 patients with preoperatively diagnosed VTE undergoing gynecological surgery between 2020 and 2022 using the Japanese Society of Anesthesiologists database. Patients were divided into malignant (M-group, n = 1126) and benign (B-group, n = 280) groups. Clinical characteristics, treatment strategies, and postoperative outcomes within 28 days after surgery were compared.

Results

Of 1406 patients, 421 (29.9%) had pulmonary embolism, 161 (11.5%) had proximal deep vein thrombosis (DVT), and 824 (58.6%) had distal DVT. Direct oral anticoagulants were the most commonly used preoperative anticoagulants (61.3%), followed by unfractionated heparin (24.8%). Postoperative anticoagulation was more frequent in the M-group than in the B-group (57.5% vs. 44.6%; p < 0.001). The 28-day all-cause mortality (1.2% vs. 0.7%; p = 0.752), VTE recurrence (2.0% vs. 2.9%; p = 0.406), and major bleeding (1.1%; p = 0.220) were comparable between groups.

Conclusions

This study provides real-world data on perioperative management and short-term outcomes in gynecological surgical patients with preoperatively diagnosed VTE in Japan. Prospective studies are required to establish optimal, risk-stratified perioperative management strategies.