Venous Thromboembolism after Surgery for Chronic Pancreatitis: Is Extended Postoperative Chemoprophylaxis Warranted?

BACKGROUND: Surgery for pancreatic cancer is associated with postoperative venous thromboembolism (VTE) rates of 5-20%, prompting routine use of extended VTE chemoprophylaxis. The incidence and predictors of VTE after CP surgery are unclear. METHODS: Retrospective single institution analysis of post-surgical patients for CP between 1/2007-6/2025. Postoperative VTE rates at 90-days were evaluated, including extremity deep vein thrombosis (DVT), pulmonary embolism (PE), and mesenteric vein thrombosis (MVT). Perioperative definitions aligned with the NSQIP and ISGPS. RESULTS: 739 patients underwent surgery for CP. Venous thrombosis developed in 50 patients (6.8%). Postoperative DVT/PE was diagnosed in 22 patients (3.0%) on postoperative day 23±20. Multivariable regression found higher BMI, lower serum albumin, and longer operative time to be risk factors for DVT/PE. Major morbidity was higher in patients that developed DVT/PE (86.3% vs. 40.2%, p <0.001); however, mortality was similar between groups (0% vs. 0.6%, p = 0.7). Postoperative MVT was diagnosed in 33 patients (4.5%) on postoperative day 23±18. Multivariable regression found organ space infection and post-pancreatectomy hemorrhage to be risk factors for MVT. Major morbidity (81.8% vs. 39.7%, p <0.001) and mortality (6.1% vs. 0.4%, p = 0.0001) were higher in patients that developed MVT. CONCLUSIONS: Extremity deep vein thrombosis, pulmonary embolism, and/or mesenteric vein thrombosis occurred in 6.8% of patients that underwent surgery for chronic pancreatitis and impact postoperative morbidity and mortality. Given this high-risk population, prospective studies optimizing strategies for postoperative chemoprophylaxis are warranted and should consider extended chemoprophylaxis and weight-based dosing.