Timing, Incidence and Risk Factors for Venous Thromboembolism in Patients Undergoing Radical Cystectomy for Malignancy: A Case for Extended Duration Pharmacological Prophylaxis

Abstract

Patients undergoing radical cystectomy for bladder cancer are at high risk for venous thromboembolism. Recent data have demonstrated that the risk of venous thromboembolism often extends beyond hospital discharge in nonurological surgical populations. To our knowledge the timing of venous thromboembolism in patients who have undergone radical cystectomy during a 30-day postoperative period has not been assessed. Therefore, we evaluated the timing, incidence and risk factors for venous thromboembolism for patients undergoing radical cystectomy for malignancy. In this descriptive, observational, retrospective study data from 1,307 patients who underwent radical cystectomy for malignancy from 2005 to 2011 were collected using the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) database. Venous thromboembolism occurrences were evaluated by postoperative day and whether they occurred while an inpatient or after discharge home. Univariate and multivariate Cox regression and logistic regression models were used to evaluate risk factors associated with venous thromboembolism. Of 1,307 patients 78 (6%) were diagnosed with venous thromboembolism. The mean time to venous thromboembolism diagnosis was 15.2 days postoperatively. Of all venous thromboembolism events 55% were diagnosed after patient discharge home. The 30-day mortality rate from venous thromboembolism was 6.4%. Risk factors for the development of venous thromboembolism on multivariate analysis were age (p = 0.024), operative time (p = 0.004) and sepsis or septic shock (p = 0.0001). More than half of all venous thromboembolisms (55%) in patients undergoing radical cystectomy for malignancy occurred after discharge home and the mean time to venous thromboembolism diagnosis was 15.2 days postoperatively. It is reasonable to consider extended duration pharmacological prophylaxis (4 weeks) in this high risk surgical population.