Timing Matters: Postoperative VTE Follows Different Timelines Across Surgical Specialties

Background The incidence and timing of postoperative venous thromboembolism (VTE) across surgical specialties remains unclear. This study aimed to evaluate the incidence and temporal pattern of VTE among a nationally representative cohort of surgical patients. Methods We analyzed data from the 2022 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Adult (≥18 years) patients undergoing common surgical procedures in general surgery, colorectal, vascular and plastic surgery, and surgical oncology and gynecology were included. Outcomes assessed included the incidence of postoperative VTE, defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), and time following surgery, in days, that the diagnosis was made. Results Of a total of 525 726 patients, 0.8% developed VTE within 30 days of the index operation, with surgical oncology having the highest rate (3%), followed by colorectal surgery (2%). The median [IQR] time to VTE diagnosis was 9[4-16] days. Among those who developed VTE, 54% were diagnosed after discharge. Plastic surgery held the highest percentage of post-discharge VTE diagnosis at 77%, but longest median time to diagnosis (10.5 days). On multivariable regression analysis, surgical oncology (aOR:1.426, P < 0.001) and colorectal surgery (aOR:1.208, P < 0.001) showed the highest odds of developing postoperative VTE but the lowest proportion diagnosed following discharge. Conclusion The temporal pattern of postoperative VTE varies substantially across surgical specialties. More than half of VTE events occurred after hospital discharge, with considerable differences in the length of time between surgery and diagnosis between groups. These findings suggest that postoperative VTE risk and temporal trends are influenced by specialty-specific perioperative practices, highlighting the need for tailored surveillance and prevention strategies.