Meta-analysis of duration of venous thromboembolism risk following hospitalization in surgical and medical patients.

OBJECTIVE

Hospitalization increases venous thromboembolism (VTE) risk, and over one-half of all VTE events occur after hospital admission. Current decisions on post-hospitalization VTE prophylaxis are not evidence-based. The duration of enhanced risk after hospitalization, in surgical and medical patients, is not well-known. In this meta-analysis, we evaluated the rates of post-hospitalization VTE over time in patients that underwent surgery during their hospitalization and those that did not.

METHODS

A literature search was performed through November 2023 using PubMed, EMBASE, and Cochrane. Studies examining the incidence of VTE in hospitalized patients during a specified period following hospitalization were included. Studies were excluded if they focused on nonhospitalized patients, failed to define the follow-up duration, or did not report the incidence of VTE. Screening and data collection was conducted by two reviewers.

RESULTS

From a total of 1504 studies screened, 57 were included. Overall, 9,152,616 patients were included; of these, 1,232,627 were followed for 30 days, 28,522 for 45 days, 2,515,940 for 90 days, and 5,375,527 were followed beyond 90 days. The pooled incidence of VTE during the first 45 days was 0.3% (95% confidence interval [CI], 0.2%- 0.4%) among surgical patients and 4.6% (95% CI, 4.3%-4.9%) among medical patients. The pooled incidence of VTE during the first 90 days was 1.3% (95% CI, 0.7%-2.3%) in surgical patients and 2.9% (95% CI, 2.0%-4.1%) in medical patients. Beyond 90 days (between 180 and 1020 days), the pooled incidence of VTE was 1.0% (95% CI, 0.4%-2.3%) in the surgical cohort, compared with 2.3% (95% CI, 1.6%-3.5%) in the medical cohort.

CONCLUSIONS

The post-hospitalization 90-day VTE rate was found to be low for both surgical and medical patients; the risks beyond 90 days was found to be only slightly lower. VTE risk in surgical patients is predominantly short-term and diminishes following recovery from surgery. Conversely, medical patients exhibit a prolonged VTE risk, likely related to persistence of clinical risk factors.