PD28-09 IMPLEMENTATION OF A PERIOPERATIVE VENOUS THROMBOEMBOLISM PROPHYLAXIS PROGRAM FOR PATIENTS UNDERGOING RADICAL CYSTECTOMY ON AN ENHANCED RECOVERY AFTER SURGERY PROTOCOL

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2018PD28-09 IMPLEMENTATION OF A PERIOPERATIVE VENOUS THROMBOEMBOLISM PROPHYLAXIS PROGRAM FOR PATIENTS UNDERGOING RADICAL CYSTECTOMY ON AN ENHANCED RECOVERY AFTER SURGERY PROTOCOL H. Abraham Chiang, Philip J. Cheng, Jacqueline M. Speed, Jill Steinberg, Peter A. Najjar, Graeme S. Steele, Quoc-Dien Trinh, Jairam R. Eswara, Steven L. Chang, Adam S. Kibel, Matthias F. Stopfkuchen-Evans, Matthew Mossanen, and Mark A. Preson H. Abraham ChiangH. Abraham Chiang More articles by this author , Philip J. ChengPhilip J. Cheng More articles by this author , Jacqueline M. SpeedJacqueline M. Speed More articles by this author , Jill SteinbergJill Steinberg More articles by this author , Peter A. NajjarPeter A. Najjar More articles by this author , Graeme S. SteeleGraeme S. Steele More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Jairam R. EswaraJairam R. Eswara More articles by this author , Steven L. ChangSteven L. Chang More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Matthias F. Stopfkuchen-EvansMatthias F. Stopfkuchen-Evans More articles by this author , Matthew MossanenMatthew Mossanen More articles by this author , and Mark A. PresonMark A. Preson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1372AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing radical cystectomy (RC) are at increased risk of venous thromboembolism (VTE). Novel VTE prophylaxis programs, including post-discharge pharmacologic prophylaxis, have been associated with decreased VTE rates. Such practices have not been widely adopted in managing post-RC patients. We therefore aimed to evaluate the effect of a perioperative VTE prophylaxis program on VTE rates after RC. METHODS We performed a single-institution, nonrandomized, pre- and post-intervention analysis of 319 patients undergoing RC between July 2011 and April 2017. Prospectively collected patient and outcomes data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database. The pre-intervention cohort received postoperative pharmacologic VTE prophylaxis in the inpatient setting. All post-intervention patients were placed on the Enhanced Recovery After Surgery (ERAS) protocol, which includes preoperative pharmacologic prophylaxis and early ambulation. The majority of post-intervention patients were discharged on a 28-day course of low-molecular-weight heparin (LMWH). Primary outcome was 30-day postoperative symptomatic VTE. Secondary outcomes were perioperative bleeding events and 30-day complication rates. Univariate analysis was performed comparing outcomes between pre- and post-intervention cohorts. RESULTS Of the 319 patients who underwent RC, 210 (66%) were in the pre- and 109 (34%) in the post-intervention cohort. VTE rate was significantly lower in the post-intervention cohort (n = 1, 0.9%) when compared to the pre-intervention cohort (n = 13, 6.2%; p = 0.04). Of note, the single VTE event in the post-intervention cohort occurred during a transition phase during which ERAS was implemented without post-discharge LMWH. Rates of perioperative bleeding events (35% vs 33%; p = 0.80) and 30-day complications (48% vs 51%; p = 0.64) did not differ significantly. CONCLUSIONS Implementation of a perioperative VTE prophylaxis program as part of an ERAS protocol that includes extended post-discharge pharmacologic prophylaxis was associated with a significantly decreased rate of VTE events after RC. Bleeding events and overall complication rate did not increase with this intervention. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e566 Advertisement Copyright & Permissions© 2018MetricsAuthor Information H. Abraham Chiang More articles by this author Philip J. Cheng More articles by this author Jacqueline M. Speed More articles by this author Jill Steinberg More articles by this author Peter A. Najjar More articles by this author Graeme S. Steele More articles by this author Quoc-Dien Trinh More articles by this author Jairam R. Eswara More articles by this author Steven L. Chang More articles by this author Adam S. Kibel More articles by this author Matthias F. Stopfkuchen-Evans More articles by this author Matthew Mossanen More articles by this author Mark A. Preson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...