The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).
Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan® Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.
Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.
Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.
Minerva urology and nephrology. 2024 Jun [Epub]
Francesco Del Giudice, Anas Tresh, Shufeng Li, Satvir Basran, Sophia G Prendiville, Federico Belladelli, Ettore DE Berardinis, Vincenzo Asero, Carlo M Scornajenghi, Dalila Carino, Matteo Ferro, Bernardo Rocco, Gian Maria Busetto, Ugo Falagario, Riccardo Autorino, Felice Crocetto, Biagio Barone, Benjamin Pradere, Wojciech Krajewski, Łukasz Nowak, Tomasz Szydełko, Marco Moschini, Andrea Mari, Simone Crivellaro, Francesco Porpiglia, Cristian Fiori, Daniele Amparore, Renate Pichler, Abhay Rane, Benjamin Challacombe, Rajesh Nair, Benjamin I Chung
Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy - ., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy., Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy., Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy., Department of Urology, University of Foggia, Foggia, Italy., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Urology Unit, Department of Surgical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy., Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France., University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland., Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy., Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy., University of Illinois Hospital and Health Sciences System, Chicago, IL, USA., Department of Urology, University of Turin, Turin, Italy., Department of Urology, Medical University of Innsbruck, Innsbruck, Austria., East Surrey Hospital, Redhill, Surrey, UK., Guy's and St. Thomas' NHS Foundation Trust, Guy's and St. Thomas' Hospital, London, UK.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38920012