Design: Retrospective cohort study of targeted hysterectomy data prospectively collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).

Setting: NSQIP Database.

Patients or Participants: Women aged 18 years or older undergoing myomectomy between 2011 and 2022. Patients further classified into two groups according to Current Procedural Terminology (CPT) codes representing low and high myoma burden (weight > 250 grams or > 1-4 fibroids removed). We excluded patients who underwent concomitant hysterectomy, vaginal myomectomies, malignant pathology and those whose operative time was missing.

Interventions: Cases were identified by CPT codes. Variables including age, ethnicity, body mass index (BMI), smoking status, diabetes, hypertension, blood transfusion, inpatient status, and American Society of Anesthesiologists classification system scores were collected. Cases were stratified by surgical route, operative time, year of procedure, and myoma burden.

Measurements and Main Results:

A total of 38,167 myomectomies occurring between 2011-2022 were included. Of these, 20,943 (54.9%) underwent laparotomy, and 17,224 (45.1%) underwent laparoscopy. The rates of VTE were 0.36% for the laparotomy group, and 0.18% for the laparoscopy group. Patients undergoing laparotomy were more likely to be younger, of non-Hispanic African American ethnicity, inpatient, with higher BMI, require blood transfusion, have higher myoma burden, and shorter operative times.

After multivariable adjustment, myoma burden and route of surgery were not independently associated with the occurrence of DVT. However, prolonged operative time (>186 min, 75 percentile) was independently associated with increased odds of VTE (aOR 2.73; CI:1.52-4.90).

Conclusion: The occurrence of VTE after laparoscopic and abdominal myomectomy is rare. The rate of VTE is higher with longer operative times, but, interestingly, this outcome is not significantly associated with route of surgery or myoma burden.