Postoperative Venous Thromboembolism Following Hysterectomy in the Department of Defense

Introduction: Hysterectomy is the most common major gynecologic procedure performed in the USA. Surgical complications, such as venous thromboembolism (VTE), are known risks that can be mitigated by preoperative risk stratification and perioperative prophylaxis. Based on recent data, the current post-hysterectomy VTE rate is found to be 0.5%. Postoperative VTE significantly impacts health care costs and patients' quality of life. Additionally, for active duty personnel, it can negatively impact military readiness. We hypothesize that the incidence of post-hysterectomy VTE rates will be lower within the military beneficiary population because of the benefits of universal health care coverage.

Materials and methods: The Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool was used to conduct a retrospective cohort study of postoperative VTE rates within 60 days of surgery among women who underwent a hysterectomy at a military treatment facility between October 1, 2013, and July 7, 2020. Patient demographics, Caprini risk assessment, preoperative VTE prophylaxis, and surgical details were obtained by chart review. Statistical analysis was performed using the chi-squared test and Student t-test.

Results: Among the 23,391 women who underwent a hysterectomy at a military treatment facility from October 2013 to July 2020, 79 (0.34%) women were diagnosed with VTE within 60 days of their surgery. This post-hysterectomy VTE incidence rate (0.34%) is significantly lower than the current national rate (0.5%, P < .0015). There were no significant differences in postoperative VTE rates with regard to race/ethnicity, active duty status, branch of service, or military rank. Most women with post-hysterectomy VTE had a moderate-to-high (4.29 ± 1.5) preoperative Caprini risk score; however, only 25% received preoperative VTE chemoprophylaxis.

Conclusion: MHS beneficiaries (active duty personnel, dependents, and retirees) have full medical coverage with little to no personal financial burden for their health care. We hypothesized a lower VTE rate in the Department of Defense because of universal access to care and a presumed younger and healthier population. The postoperative VTE incidence was significantly lower in the military beneficiary population (0.34%) compared to the reported national incidence (0.5%). Additionally, despite all VTE cases having moderate-to-high preoperative Caprini risk scores, the majority (75%) received only sequential compression devices for preoperative VTE prophylaxis. Although post-hysterectomy VTE rates are low within the Department of Defense, additional prospective studies are needed to determine if stricter adherence to preoperative chemoprophylaxis can further reduce post-hysterectomy VTE rates within the MHS.