PD41-11 NATIONWIDE UTILIZATION OF CHEMOPROPHYLAXIS FOR THE PREVENTION OF VENOUS THROMBOEMBOLISM FOLLOWING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2018PD41-11 NATIONWIDE UTILIZATION OF CHEMOPROPHYLAXIS FOR THE PREVENTION OF VENOUS THROMBOEMBOLISM FOLLOWING RADICAL CYSTECTOMY Stephen Reese, Matthew Mossanen, Dimitar Zlatev, Daniel Pucheril, Benjamin I. Chung, and Steven L. Chang Stephen ReeseStephen Reese More articles by this author , Matthew MossanenMatthew Mossanen More articles by this author , Dimitar ZlatevDimitar Zlatev More articles by this author , Daniel PucherilDaniel Pucheril More articles by this author , Benjamin I. ChungBenjamin I. Chung More articles by this author , and Steven L. ChangSteven L. Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1950AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major preventable source of postoperative complications. The risk of VTE in patients undergoing radical cystectomy (RC) for bladder cancer has been estimated at 6%, and the American Urological Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network all recommend perioperative chemoprophylaxis. We performed a population-based analysis to determine the utilization of chemoprophylaxis against VTE in patients undergoing RC. METHODS Using the Premier Hospital Database (Premier, Inc., Charlotte, NC), we retrospectively identified patients who underwent RC for bladder cancer in the US between 2006 and 2015. Administration of chemoprophylaxis within 24 hours of surgery was deemed consistent with recommendations. A subgroup analysis of higher volume hospitals (≥10 RC annually) compared outcomes of DVT, PE, and bleeding between patients in hospitals with uniform use versus no use of chemoprophylaxis. Multivariate analysis was used to evaluate predictors of under-utilization of chemoprophylaxis. RESULTS Among the cohort of 9,133 patients (48,714 patients after weighting adjustment) undergoing RC, 35.1% were administered recommended chemoprophylaxis, with an increase in utilization from 20.7% in 2006 to 49.6% in 2015. Characteristics associated with decreased likelihood of chemoprophylaxis administration included patient age ≥ 65 years, Charlson Comorbidity Index score ≥ 2, rural hospital location, commercial insurance, and year of surgery prior to 2010. Patients who received recommended chemoprophylaxis had significantly lower rates of VTE (5.1% vs. 6.0%) and PE (2.0% vs. 3.1%), but elevated rates of bleeding (12.8% vs. 7.7%). CONCLUSIONS Although there has been a progressive increase in the utilization of chemoprophylaxis following RC, this recommendation by multiple medical groups has been adopted in a limited fashion in the United States. Greater compliance with recommended use of chemoprophylaxis following RC may be associated with decreased risk of PE and VTE, but also with increased risk of bleeding. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e813 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Stephen Reese More articles by this author Matthew Mossanen More articles by this author Dimitar Zlatev More articles by this author Daniel Pucheril More articles by this author Benjamin I. Chung More articles by this author Steven L. Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...