Exceedingly High Rate of Venous Thromboembolism after Laparoscopic Splenectomy Warrants a Chemoprevention Guideline

INTRODUCTION: Venous thromboembolism (VTE) after elective laparoscopic splenectomy (LS) historically ranges from 0.8% to 3%, which is higher than other types of elective noncardiac procedures. These patients often have multiple risk factors for VTE. However, no guideline exists to aid surgeons in minimizing VTE. The purpose of this study is to define the associated risk and rate of VTE after LS. METHODS: The American College of Surgeons NSQIP database was queried from 2005 to 2020. Patients were identified based on the CPT code 38120. Patients were further excluded if they were coded as emergent or being transported to the hospital from any location other than home. Analysis of the data was performed with RStudio and Microsoft Excel. RESULTS: A total of 5,176 patients underwent LS with a VTE rate of 3.6% and average Caprini score of 4. Among these, 67% had surgical indication or a postoperative diagnosis that confers increased risk of VTE, such as active malignancy or autoimmune disease. 100% of patients had full data available for all relevant outcomes except for postoperative diagnosis, in which 97% of patients had this information recorded (Table),TableCONCLUSION: LS patients are very high risk for VTE, even more so than patients undergoing bariatric or total joint surgery. These patients should be strongly considered for both preoperative and postoperative VTE chemoprophylaxis. Additional research should be performed investigating the role of prolonged postoperative VTE chemoprophylaxis after discharge.