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BACKGROUND Venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most common cause of preventable deaths in hospitalized patients in the United States. Although the risk of VTE in benign gynecologic surgery is generally low, the potential for VTE in urogynecologic population is significant because the majority of patients undergoing Pelvic Organ Prolapse (POP) surgery have increased surgical risk factors. OBJECTIVE To investigate incidence and risk factors for VTE within 30-days after different routes of POP surgery in a large, cohort population using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). STUDY DESIGN This was a retrospective-cohort study utilizing Current Procedural Terminology (CPT) codes to identify POP repairs with and without concurrent hysterectomy performed during 2011-2017 in the ACS-NSQIP database. Demographics, preoperative length of hospital stay, operative time, preoperative comorbidities, smoking status, American Society of Anesthesiologists (ASA) classification system scores, along with other variables were collected. Postoperative 30-day complications, including readmission, reoperation, and mortality were collected. The incidence rates of VTE, as defined by ACS-NSQIP, were compared among different surgical routes. Descriptive statistics were utilized, and logistic regression was performed to identify associations. RESULTS Among 91,480 POP surgeries identified, 63,108 were analyzed: 43,279 (68.6%) were performed vaginally; 16,518 (26.2%) laparoscopically; and, 3,311 (5.2%) abdominally. 34,698 (55.0%) underwent a concurrent hysterectomy. One hundred-thirty-three out of 63,108 subjects developed VTE within 30-days after surgery (0.21%; 95% Confidence Interval [CI], 0.18-0.25, p<.0001). 60 % of VTE occurred within 10 days after surgery. For all surgical routes, older age (p<.041), higher body mass index (BMI) (p=.002), race/ethnicity (p=.04), longer operating time (p<.0001), inpatient status (p<.0001), ASA 3 or 4 (p<.0001), having preoperative renal failure (p=.001), and chronic steroid use (p=.02) were significantly associated with VTE. Additionally, in the vaginal POP repair group, concurrent hysterectomy (p=.03) and preoperative dyspnea (p=.01) were associated with development of VTE. In the abdominal POP repair, concurrent hysterectomy (p=.005) and hypertension requiring medication (p=.04) was also independently associated with VTE development (Table 1). The incidence of VTE was highest in abdominal repairs (0.72%), followed by laparoscopic repairs (0.25%), and vaginal repairs (0.16%). After adjusting for confounders, abdominal compared to vaginal approach (adjusted Odds Ratio [aOR]=3.27; 95% CI, 1.93-5.41, p<.0001), longer operative time (aOR=1.005; 95% CI, 1.003-1.006, p<.0001), older age (aOR=1.020; 95% CI, 1.00-1.037, p=.015), greater BMI (aOR=1.04; 95% CI, 1.01-1.07, p=.0006), ASA 3 or 4 (aOR=1.55; 95% CI, 1.03-2.31, p=.03), and preoperative renal failure (aOR=8.87, 95% CI, 1.16-44.15, p=.04) remained significantly associated with developing VTE. Neither laparoscopic repair (compared to vaginal repair) nor concurrent procedures (hysterectomy, anti-incontinence procedure, vaginal mesh insertion) were found to be significantly associated with development of VTE. The abdominal POP repairs were associated with an increased hazard of VTE (HR=3.27, 95% CI, 1.96-5.45, p<.0001). VTE development was associated with 30-day mortality, readmission, and reoperation (all p<.0001). CONCLUSION(S) The overall incidence of VTE after POP repairs based on a recent, large cohort database was very low confirming the finding in prior smaller cohort studies. The highest VTE risk was associated with abdominal route, and greater than 60% of VTE occurred within 10 days after surgery. Thus, focus should be placed on risk reducing strategies in the immediate postoperative period, with greater emphasis on patients undergoing abdominal surgery.