Incidence, Risk Factors, and Outcomes of VTE in Surgical and Obstetric Patients: A Systematic Review

Abstract

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality in hospitalized patients. Surgery and pregnancy are well-established high-risk conditions, but incidence, risk factors, and outcomes vary across populations. To systematically review the incidence, risk factors, and outcomes of VTE in surgical and obstetric patients. Following PRISMA guidelines, we searched Medline/PubMed, Embase, and Cochrane Library for studies (1990–2025) reporting VTE in surgical or obstetric populations. Cohort, case-control, and clinical studies providing data on incidence, risk factors, and outcomes were included. Data were abstracted on patient characteristics, VTE incidence, risk factors, and clinical outcomes. Postoperative VTE incidence ranges from 0.2–2% in general surgical populations and up to 4.5% in high-risk orthopedic patients without prophylaxis. Advanced age, active cancer, prolonged operative time, and major trauma are consistent surgical risk factors. Pregnancy-associated VTE is rare (~0.6–1.4 per 1000 pregnancies) but increases 3–10-fold antepartum and 12–35-fold postpartum, with cesarean delivery, thrombophilia, obesity, and infection as major contributors. VTE significantly impacts outcomes: 30-day mortality is 10–30% in surgical patients and PE accounts for 10–15% of maternal deaths. Post-thrombotic syndrome and recurrent VTE are common sequelae. VTE remains a clinically important complication in surgical and obstetric populations. Awareness of patient-specific and procedure-specific risk factors, along with adherence to prophylaxis guidelines, is critical to reduce morbidity and mortality.