82 SYMPTOMATIC PULMONARY EMBOLISM IN MAJOR UROLOGIC CANCER SURGERY

Abstract

INTRODUCTION AND OBJECTIVES: Venous thromboembolic events (VTE ), which progress from deep vein thrombosis (DVT) to pulmonary embolism (PE), are the most common preventable cause of hospital death. In urology, older obese patients with cancer frequently undergo major abdominal and pelvic surgery, which places them at the highest risk for VTE. Data describing VTE risk in urology is lacking because it is difficult to estimate risk retrospectively and early events (DVT) may be asymptomatic. However, PE is an ideal surrogate measure because it represents the furthest progression of VTE and is often symptomatic. The objective of this study was to evaluate the incidence and outcomes for symptomatic PE in cancer patients after prostatectomy, nephrectomy or cystectomy during a 5year period at a tertiary medical center. METHODS: Clinical and pathologic data was reviewed for all prostatectomy, nephrectomy, and cystectomy patients with a cancer diagnosis from January 1st 2006-December 31st 2010. All patients had mechanical prophylaxis per hospital protocol. Heparin prophylaxis is not routinely given for nephrectomy or prostatectomy. Routine heparin prophylaxis after cystectomy began in 2010. Symptomatic PE was assumed to be related to surgery if diagnosed within 90 days following surgery. Two patients with incidental PE were not included. RESULTS: A total of 1327 patients met eligibility criteria. The overall symptomatic PE incidence was 1.6% (21/1327), including 6/827(0.7%) for prostatectomy, 4/307(1.3%) for nephrectomy and 11/ 189(5.8%) for cystectomy. Death resulted from PE in 2/21(9.5%) of patients (2 postcystectomy). Patients with symptomatic PE had mean age of 64.7 years (44-81). SOB was the most common presenting symptom (58.8%), and diagnosis was most commonly obtained from CT chest angiography (81.0%). The average time from symptoms to diagnosis was 1.3 days (0-11). PE was diagnosed during the initial hospital stay in 11 of 21(52.4%) of patients. PE was diagnosed in 16/21(76.2% )on days 0-30, 3/31 (14.3%)on days 31-60 and 2/21(9.5%) on days 61-90 postoperatively. Hospital readmission for PE was required in 10 patients for 81 hospital days. In post-cystectomy PE patients, 6/11(54%) received heparin prophylaxis at any time (27% presurgery). In post-cystectomy patients without PE, 26/178(15%) were given prophylactic heparin at any time (6.1% presurgery). CONCLUSIONS: Symptomatic PE is rare after prostatectomy or nephrectomy, but common after cystectomy. VTE incidence after cystectomy is significantly elevated and extended heparin prophylaxis should be considered in these patients.