MP64-14 OUTPATIENT CHEMOPROPHYLAXIS AND RATE OF DEEP VENOUS THROMBOSIS FOLLOWING RADICAL CYSTECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Radical cystectomy is associated with significant morbidity (20-60%) and mortality (1-6%). Despite ubiquitous postoperative prophylaxis in the inpatient setting, deep venous thrombosis (DVT) and venous thromboembolism (VTE) are common following cystectomy (2-9%) and contribute significantly to morbidity and mortality (6.8%). The mean time to DVT and VTE is postoperative day 15.2, suggesting that the risk of DVT and VTE persists following discharge. We sought to evaluate the benefit of extended chemoprophylaxis after hospital discharge following cystectomy in reducing incidence of deep venous thrombosis and venous thromboembolism. METHODS: Beginning in 2012, we prospectively instituted a policy of immediate pre-procedure prophylaxis with a single dose of subcutaneous heparin and continued prophylaxis with subcutaneous heparin/enoxaparin for 30 days post-operatively. We reviewed the charts of all patients who underwent radical cystectomy at our institution from January 2012-December 2013. After excluding patients who were on chronic anticoagulation for other indications as well as those who developed DVT prior to discharge, 58 patients were analyzed. The experimental group (n1⁄417) consisted of patients who received extended chemoprophylaxis while the control group (n1⁄4 41) received no chemical prophylaxis on discharge. The decision to discharge with or without prophylaxis was up to surgeon discretion at the time of discharge. The primary outcome was incidence of DVT or VTE. Secondary outcomes included overall complication rate, hemorrhagic complication rate and readmission rate. RESULTS: The cohort contained 45 men and 13 women. 44 patients underwent ileal conduit and 14 underwent continent diversion. Median age was 64.5 (range 52 to 87). The experimental group experienced a trend towards a lower rate of post-discharge DVT assessed as of 90 days postoperatively when compared to the control rate (5.8% vs. 9.8%), a 40% relative risk reduction (p1⁄40.63). There were no significant differences in secondary outcomes including rate of readmission (41% vs 42%), hemorrhagic complications (2.5% vs 5.8%) or overall complication rate (52% vs 66%). There were no significant demographic differences between control and experimental groups. CONCLUSIONS: Immediate preoperative followed by extended outpatient chemoprophylaxis following radical cystectomy is well tolerated and is associated with a trend towards lower rate of deep venous thrombosis.