BERKELEY, CA (UroToday.com) - Venous thromboembolism (VTE) after urological surgery is a source of preventable adverse outcomes for our patients. The latest 2012 American College of Chest Physicians guidelines for the use of VTE prevention now recommend the use of both pharmacologic and mechanical prophylaxis for men having open or laparoscopic prostatectomy. In our recently published manuscript, we explored the use of VTE prophylaxis at the time of prostatectomy, both open and robotic or laparoscopic procedures. We reviewed a prospective nationwide database used to measure health outcomes. The major outcomes were use of VTE prophylaxis within 24 hours of surgery and the occurrence of VTE during hospitalization.
We found that 71% of men having prostatectomy received some form of VTE prophylaxis within 24 hours of surgery. Mechanical compression devices were worn by 48.7%, 10% received pharmacological prophylaxis alone, and another 12.8% received both. While the usage pattern is encouraging, 30% of men still received no VTE prophylaxis at all. Over the previous decade, there has been improvement, with non-usage decreasing from 34% to 26% in 2010. We see this as an opportunity for additional improvement to further decrease risk for our patients and promote a culture of patient safety.
Use of pharmacologic VTE prophylaxis is sometimes cited to be a cause of increased surgical bleeding. In this large cohort, prophylaxis did not increase the transfusion rate. In line with the 2012 ACCP guidelines, we advocate for the use of combined pharmacologic and mechanical prophylaxis for all men undergoing prostate cancer surgery to reduce the risk of VTE, a major preventable clinical event.
Written by:
Aaron C. Weinberg, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Columbia University Medical Center, New York, NY, USA
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