Venous Thromboembolism in Minimally Invasive Compared With Open Hysterectomy for Endometrial Cancer

Abstract

Objective

To evaluate whether minimally invasive surgery for endometrial cancer is independently associated with a decreased odds of venous thromboembolism compared with open surgery.

Methods

We performed a secondary analysis cohort study of prospectively collected quality improvement data and examined patients undergoing hysterectomy for endometrial cancer from 2008–2013 recorded in the National Surgical Quality Improvement Program database. Patients undergoing minimally invasive (laparoscopic or robotic) versus open surgery were compared with respect to 30-day postoperative venous thromboembolism. Demographic and procedure variables were examined as potential confounders. Data regarding receipt of perioperative venous thromboembolism prophylaxis was not available. Bivariable tests and logistic regression were used for analysis.

Results

Of 9,948 patients who underwent hysterectomy for the treatment of endometrial cancer, 61.9% underwent minimally invasive surgery and 38.1% underwent open surgery. Patients undergoing minimally invasive surgery had a lower venous thromboembolism incidence (0.7%, n=47) than open surgery patients (2.2%, n=80) (p<0.001). In a multivariate model adjusting for age, BMI, race, operative time, Charlson comorbidity score, and surgical complexity, minimally invasive surgery remained associated with decreased odds of venous thromboembolism (aOR 0.36, 95% CI 0.24–0.53) compared with open surgery.

Conclusions

Minimally invasive surgery for the treatment of endometrial cancer is independently associated with decreased odds of venous thromboembolism compared with open surgery.

PRECIS

Minimally invasive surgery for endometrial cancer is associated with a lower incidence of venous thromboembolism compared with open surgery.