Incidence and risk factors for lower-extremity deep vein thrombosis in postoperative patients with spontaneous intracerebral hemorrhage: A systematic review and meta-analysis.

BACKGROUND

Postoperative lower-extremity deep vein thrombosis (DVT) is a clinically important complication after surgery for spontaneous intracerebral hemorrhage. Reported DVT incidence and associated risk factors vary across studies because of differences in patient characteristics, surgical procedures, assessment windows, and screening strategies. This meta-analysis aimed to synthesize the currently available observational evidence on the incidence and risk factors of lower-extremity DVT after surgery for spontaneous or hypertensive intracerebral hemorrhage.

METHODS

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses -compliant review was registered in International Prospective Register of Systematic Reviews. PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, and China Science and Technology Journal were searched from inception to April 24, 2026. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled incidence estimates were calculated using a random-effects model. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for clinically comparable risk factors using fixed-effect or random-effects models according to between-study heterogeneity. Subgroup analysis, leave-one-out sensitivity analysis, funnel-plot assessment, and exploratory Egger regression were performed where appropriate.

RESULTS

Fifteen observational studies involving 3378 patients were included, all of which were conducted in China. Fourteen studies comprising 3280 patients and 683 DVT events contributed to the incidence analysis. The pooled incidence of postoperative lower-extremity DVT was 23% (95% CI: 18%-28%; I2 = 91.96%), and leave-one-out sensitivity analysis showed estimates ranging from 21% to 24%. Factors associated with higher odds of DVT included older age (OR = 2.45, 95% CI: 1.76-3.39), elevated D-dimer level (OR = 1.03, 95% CI: 1.01-1.05), higher Caprini score (OR = 2.39, 95% CI: 1.55-3.67), hypertension (OR = 3.69, 95% CI: 2.31-5.88), diabetes mellitus (OR = 2.58, 95% CI: 1.52-4.38), prolonged bedridden duration (OR = 4.30, 95% CI: 2.91-6.37), postoperative lower-limb motor dysfunction (OR = 3.59, 95% CI: 1.16-11.13), and venous catheterization (OR = 2.57, 95% CI: 1.98-3.33).

CONCLUSION

Available Chinese observational evidence suggests that postoperative lower-extremity DVT is frequently reported after surgery for spontaneous or hypertensive intracerebral hemorrhage. Its occurrence is associated with impaired mobility, coagulation activation, vascular-metabolic comorbidity, and perioperative invasive exposure. Given the observational evidence base, geographical concentration, and substantial heterogeneity, prospective multicenter studies with standardized screening protocols are needed to confirm these findings and optimize postoperative DVT prevention strategies.