Retrospective study of venous thromboembolism after breast cancer surgery: incidence, predictive factors, and outcomes

Breast cancer surgery is generally considered to be low risk for venous thromboembolism (VTE). However, when VTE occurs, it may lead to severe complications and increased mortality. A retrospective study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2023) investigated the incidence, predictors, and clinical impact of postoperative VTE following breast cancer surgery without concurrent reconstruction among 270,564 female patients. Of these, 465 (0.2%) developed postoperative VTE: 247 (53.1%) deep vein thrombosis; 177 (38.1%) pulmonary embolism; and 41 (8.8%) both. Patients who developed VTE were older, had higher body mass index (BMI), greater comorbidity burden, and longer operative times (all p<0.001). They also demonstrated lower preoperative serum albumin, hematocrit, prothrombin time, and albumin-to-creatinine ratio. VTE was associated with significantly longer hospital stays, increased rates of reoperation and readmission, and a more than 20-fold higher crude 30-day mortality (1.9% versus 0.1%) (all p<0.001). In multivariable analysis, increasing age (OR 1.26 per 10 years), BMI (OR 1.17 per 5 kg/m