Postoperative VTE Timing and Prevention Vary Across Surgical Specialties

Campwala I, Lu L, Humar P, et al. Effect of Surgical Subspecialty on Time to Development of Postoperative Venous Thromboembolism. J Am Coll Surg. September 2026.

Venous thromboembolism (VTE) continues to cause substantial postoperative morbidity despite preventive guidelines. Campwala et al. examined differences in VTE onset and thromboprophylaxis across surgical specialties.

The retrospective study included adults who developed imaging-confirmed VTE during their surgical hospitalization in a multihospital system between 2013 and 2019. Investigators identified events through natural language processing and verified them through chart review. Analyses assessed time to VTE and initiation of prophylaxis.

Among 1,520 affected patients, 24.9% had deep vein thrombosis (DVT), 67.2% had pulmonary embolism (PE), and 7.9% had both. VTE developed a median of 4 days after surgery; PE appeared earlier than DVT (3 versus 6 days; p<0.001). Neurosurgery had the greatest VTE incidence, at 0.23% of procedures, while orthopedic surgery had the highest adjusted hazard of postoperative VTE.

Among patients who developed VTE, 76% received postoperative prophylaxis, starting a median of 1.3 days after surgery. VTE occurred earlier among patients without prophylaxis (2 versus 4 days; p<0.001). Adjusted prophylaxis initiation was lowest in cardiac surgery and highest in thoracic surgery; trauma patients also had a lower likelihood of receiving prophylaxis.

The findings suggest that specialty-specific risk assessment, preventive approaches, and surveillance may help address variation in postoperative VTE.