Incidence and Risk Factors for Venous Thromboembolism Events After Rectal Prolapse Surgery

BACKGROUND: The most common cause of preventable death in hospitalized patients in the United States is venous thromboembolism. While pelvic organ prolapse surgery in urogynecology literature reports rates < 1%, the rate of venous thromboembolism for rectal prolapse surgery remains undescribed. We hypothesized that the rate of venous thromboembolism with rectal prolapse surgery would be low and that risk factors would include surgical approach, body mass index, longer operative time, older age, renal failure, and functional status. OBJECTIVE: Define the incidence and identify risk factors and associated with venous thromboembolism events in the 30-day postoperative period following rectal prolapse surgery. DATA SOURCES: A retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement Program between 2005-2021. STUDY SELECTION: Patients with Current Procedural Terminology codes to identify rectal prolapse procedures. MAIN OUTCOME MEASURES: Incidence of venous thromboembolism and risk factors. RESULTS: A total of 19,197 rectal prolapse procedures were analyzed. Overall, 61 (0.32%) patients developed venous thromboembolism within 30 days of surgery. More than 60% (37) of the venous thromboemboli developed within two weeks of the operation. On multivariable analysis, dependent functional status was an independent risk factor for venous thromboembolism after surgery for rectal prolapse (odds ratio 2.62 [1.31,4.87]) and longer length of stay (odds ratio 1.048 [1.028, 1.65]), postoperative surgical site infections (odds ratio 3.59 [1.61, 7.17]), and bleeding (odds ratio 4.35 [1.864, 8.92]) were associated with venous thromboembolism. LIMITATIONS: Unable to assess perioperative chemoprophylaxis use. CONCLUSIONS: The overall incidence of venous thromboembolism after rectal prolapse repair is very low similar to that reported in the literature examining venous thromboembolism after pelvic organ prolapse repair. Most venous thromboembolic events occurred within the first two weeks of surgery. Preoperative dependent functional status, postoperative bleeding, and surgical site infection were identified as independent risk factors for venous thromboembolism. See Video Abstract.