PURPOSE: Patients undergoing radical cystectomy for bladder cancer are at high risk for development of venous thromboembolism.
Recent data has demonstrated the risk of VTE often extends beyond hospital discharge in non-urologic surgical populations. The timing of VTE occurrence in radical cystectomy patients over a 30 day post-operative period has not been assessed. We evaluated the timing, incidence, and risk factors of VTE for patients undergoing RC for malignancy.
MATERIALS AND METHODS: This is a descriptive observational retrospective study. Data from 1,307 patients who underwent RC for malignancy from 2005-2011 were collected using the American College of Surgeons National Surgical Quality Improvement Program database. VTE occurrences were evaluated by postoperative day and whether they occurred while inpatient or after discharge. Univariate and multivariable Cox regression and logistic regression models were used to evaluate risk factors associated with VTE.
RESULTS: Seventy-eight of 1307 patients (6%) was diagnosed with VTE. The mean time to VTE diagnosis was 15.2 days post-operatively. Fifty-five percent of all VTE events were diagnosed after patient discharge. The 30 day mortality rate from VTE was 6.4%. Risk factors for development of VTE on multivariable analysis were age (p=0.024), operative time (p=0.004), and sepsis or septic shock (p=0.0001).
CONCLUSIONS: More than half of all VTEs (55%) in patients undergoing RC for malignancy occurred following patient discharge and the mean time to VTE diagnosis was 15.2 days postoperatively. It is reasonable to consider extended duration pharmacologic prophylaxis (4 weeks) in this high risk surgical population.
Written by:
Vandlac AA, Cowan NG, Chen Y, Anderson RE, Conlin MJ, La Rochelle JC, Amling CL, Koppie TM. Are you the author?
Department of Urology, Oregon Health and Science University.
Reference: J Urol. 2013 Oct 29. pii: S0022-5347(13)05835-7.
doi: 10.1016/j.juro.2013.10.096
PubMed Abstract
PMID: 24184368
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