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Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis?

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Abstract

Robotic surgery for gynecologic malignancy is associated with a lower rate of venous thromboembolism (VTE) than laparotomy. Obese patients represent a particularly high-risk group for VTE, but prior studies tend to focus on patients with a much lower BMI and without extended VTE prophylaxis. Our objective was to examine the role of extended thromboprophylaxis in obese patients who underwent robotic-assisted surgery for endometrial cancer. We conducted a retrospective cohort study of obese patients (BMI ≥ 35 kg/m2) who underwent robotic surgery for newly diagnosed endometrial cancer. The primary outcome measured was the occurrence of a VTE event within the 30-day postoperative period. The Farrington–Manning score test was used for equivalence analysis with a 5% margin. Secondary outcomes were perioperative complications. One hundred thirty-two robotic cases for endometrial cancer met our criteria. One hundred twenty-one (92%) received preoperative pharmacologic thromboprophylaxis, and 100% used pneumatic compression devices. Ninety-three percent and 90% received preoperative pharmacologic prophylaxis in the extended and no extended group, respectively (p-value = 0.7). Seventy patients (54%) received 4-week extended prophylaxis. Estimated blood loss was similar in both groups (75 mL vs 60 mL, p-value = 0.6). Perioperative complications and readmissions were similar between the two groups. There were no VTE events during hospital stay. One patient in the group that did not receive extended prophylaxis developed a VTE in the 30-day postoperative period (1.6%), versus 0% in the group that did receive extended prophylaxis (p-value = 0.1). The risk of VTE was low. The absence of extended VTE prophylaxis did not significantly increase the risk for VTE in obese patients with newly diagnosed endometrial cancer who underwent robotic-assisted surgery.

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Authors and Affiliations

  1. Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    Semiramis L. Carbajal-Mamani, Bahram Dideban & Bernie Amaro

  2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610, USA

    David Schweer & Joel Cardenas-Goicoechea

  3. Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, 28232, USA

    Kristi T. Balavage

  4. Department of Gynecologic Oncology, Danbury Hospital, Western Connecticut Health Network, Connecticut, 06810, USA

    Linus Chuang

  5. Division of Quantitative Science and Biostatistics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, 32611, USA

    Yu Wang, Shu Wang & Ji-Hyun Lee

  6. Department of Biostatistics, University of Florida College of Medicine, Gainesville, FL, 32611, USA

    Yu Wang, Shu Wang & Ji-Hyun Lee

Authors
  1. Semiramis L. Carbajal-Mamani
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  2. Bahram Dideban
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  3. David Schweer
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  4. Kristi T. Balavage
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  5. Linus Chuang
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  6. Yu Wang
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  7. Shu Wang
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  8. Ji-Hyun Lee
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  9. Bernie Amaro
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  10. Joel Cardenas-Goicoechea
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Corresponding author

Correspondence to Joel Cardenas-Goicoechea.

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Conflict of interest

Authors SLCM, BD, DS, KTB, LC, YW, SW, JHL, BA, and JCG declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Carbajal-Mamani, S.L., Dideban, B., Schweer, D. et al. Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis?. J Robotic Surg 15, 343–348 (2021). https://doi.org/10.1007/s11701-020-01110-6

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  • DOI: https://doi.org/10.1007/s11701-020-01110-6

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