Background:  Venous thromboembolism (VTE) is a serious complication following gynaecological surgery, with malignancy placing patients at an even greater risk.

Aims:  To review the incidence of VTE following gynaecological surgery for suspected or confirmed malignancy with respect to prophylactic modalities and to assess the incidence and associated risk factors for bleeding complications.

Methods:  A retrospective cohort study was undertaken between 2001 to 2006 on 1363 women undergoing surgery for suspected or confirmed gynaecological malignancy. Data on demographic details, diagnosis, radiotherapy/chemotherapy treatment, operative details, and hospital length of stay (LOS), thromboprophylaxis, in‐hospital and 3‐month readmission rates for deep vein thrombosis (DVT) and/or pulmonary embolism (PE) were collected.

Results:  Median age was 54 years (IQR 44–66) and hospital LOS 7 days (IQR 5–9). 51.6% had a new malignancy and 33.0% benign disease. All in‐hospital VTE events (0.4%; 95% CI 0.2–1.0%) occurred in women with advanced malignancy. VTE rate was 1.5% (95% CI 1.0–2.3%) at 3 months. In‐hospital and 3‐month non fatal PE occurred in 0.4% (95% CI 0.2–0.9%) and 1.1% (95% CI 0.7–1.8%) respectively, with a fatal PE rate of 0.1% (95% CI 0.04–0.5%). Malignancy (OR 10.3; 95% CI 1.3–80.6; P = 0.026) and duration of surgery (OR 2.1; 95% CI 1.4–3.2; P = 0.001) significantly increased bleeding risk.

Conclusions:  In‐hospital VTE risk is higher following gynaecological surgery for malignancy than for benign disease, despite the use of thromboprophylaxis. Given the higher non fatal PE rate after discharge and increasing trend towards shorter hospital LOS, extended prophylaxis in these patients should be considered.