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Blood transfusions increase the risk of venous thromboembolism following ventral hernia repair

  • J. H. Helm
  • M. C. Helm
  • T. L. Kindel
  • J. C. Gould
  • R. M. HigginsEmail author
Original Article
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia



Blood transfusions can affect the clotting cascade, leading to a hypercoagulable state. The association of a venous thromboembolic (VTE) event and perioperative blood transfusion has been identified previously in surgical patients, but not after ventral hernia repair (VHR). The aim of this study was to evaluate the risk of VTE in VHR patients who receive a perioperative blood transfusion.


The American College of Surgeons National Surgery Quality Improvement Program was queried for open (n = 34,687) and laparoscopic (n = 11,544) VHRs that occurred from 2013 to 2015. Regression analyses were used to determine factors predictive of VTE within 30-day post-operatively, the impact of bleeding requiring blood transfusion, and the influence of surgical approach on VTE.


Post-operative VTE occurred in 246 (0.5%) VHR patients. Among those patients, 53.0% occurred after discharge. Increased age, operative time, and comorbidities increased the risk of VTE (p < 0.05). Controlling for surgical approach, perioperative blood transfusion increased the risk of VTE 10.2-fold (p < 0.0001) in open and 12.2-fold in laparoscopic VHR (p < 0.0001).


Perioperative blood transfusions are associated with an increased rate of VTE following VHR, more than 50% of which occur after discharge. This study highlights the importance of identifying quality initiatives for at risk patients, including adequate VTE screening and potential prophylaxis for those who receive perioperative blood transfusions.


Venous thromboembolism NSQIP Blood transfusion Ventral hernia 


Compliance with ethical standards

Conflict of interest

Dr. Joseph Helm, Ms. Melissa Helm, and Dr. Tammy Kindel have nothing to disclose. Dr. Rana Higgins is a proctor for Intuitive Surgical and a speaker for W.L. Gore. Dr. Jon Gould is a consultant for Torax Medical. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Ethical approval

IRB approval from our institution was obtained for the research study.

Human and animal rights

This study was conducted using a large national database, ACS-NSQIP, with completely de-identified data.

Informed consent

Informed consent was not needed as the ACS NSQIP data is not identifiable in any way and no individual patient or hospital information can be accessed. No protected health information was used for this project.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • J. H. Helm
    • 1
  • M. C. Helm
    • 1
  • T. L. Kindel
    • 1
  • J. C. Gould
    • 1
  • R. M. Higgins
    • 1
    Email author
  1. 1.Division of General Surgery, Department of SurgeryMedical College of WisconsinMilwaukeeUSA

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