Background <p>Postoperative venous thromboembolism (VTE) is a common and life-threatening complication in ovarian cancer surgery, which not only prolongs the patient’s hospital stay but also increases the risk of postoperative death. Based on this, this study aims to explore the factors affecting the incidence of postoperative VTE in ovarian cancer patients, so as to provide a reference for clinical risk assessment and targeted prophylactic measures.</p> Methods <p>A retrospective study was conducted involving 67 patients with ovarian cancer who developed postoperative VTE at our hospital. The period we considered for our study was between August 2020 and August 2022. We also looked at 100 patients who did not experience postoperative VTE, which was confirmed by imaging during the same period. To comprehensively capture the occurrence of postoperative VTE, all 167 enrolled patients underwent systematic imaging examinations within 1 month after surgery - abdominal and lower extremity vascular ultrasound was performed for all patients at 1 week and 3 weeks postoperatively, and contrast-enhanced computed tomography (CTA) was further conducted for patients with suspicious ultrasound findings. No imaging examination was limited to only symptomatic patients; this systematic screening method ensured no missed diagnosis of asymptomatic VTE cases. Clinical data from both groups were analyzed and compared to identify risk factors associated with postoperative VTE in patients with ovarian cancer. We observed the time when the blood clot appeared, which was one month after the operation.</p> Results <p>The univariate analysis revealed statistically significant differences between the two groups with respect to age, hypertension, menopausal status, neoadjuvant chemotherapy, FIGO tumor stage, lymph node metastasis, operation duration, and preoperative plasma levels of fibrinogen (FIB) and D-dimer (all <i>P</i> &lt; 0.05). Multivariate analysis identified advanced age, neoadjuvant chemotherapy, advanced FIGO stage, and elevated preoperative plasma levels of FIB and D-dimer as independent risk factors for postoperative VTE in patients with ovarian cancer (all <i>P</i> &lt; 0.05).</p> Conclusion <p>Advanced age, neoadjuvant chemotherapy, advanced FIGO tumor stage, and elevated preoperative levels of plasma FIB and D-dimer are significant risk factors for postoperative VTE in patients with ovarian cancer. Enhanced perioperative clinical management of patients identified as high risk is recommended to mitigate the incidence of postoperative VTE in this population.</p>