Use of Pre-operative Pharmacologic Venous Thromboembolism Prophylaxis for Robotic Partial Nephrectomy

Abstract

To determine whether a single dose of preoperative enoxaparin for venous thromboembolism (VTE) prophylaxis impacts rates of thrombotic and bleeding events after robotic partial nephrectomy (RPNx). A retrospective cohort study of RPNx patients from 2009 to 2020 was performed. Clinical characteristics and perioperative outcomes were compared between patients receiving a single dose of preoperative enoxaparin and those who did not. The primary outcome was 30-day hemorrhagic complications (transfusion≥2 units,embolization, or reoperationfor bleeding). Secondary outcomes were30-day VTE events. Multivariable logistic regression was performed to control for significant differences between groups and to identify predictors of hemorrhagic complications among patients. Among 945 RPNx procedures, 794 (84%) received preoperative enoxaparin (PPx)and 151 (16%) did not (NPPx).The PPx cohort was older (P = .004), had lower BMI (P = .03),lower ASA class (P = .049), and fewer smokers (P = .03). Warm ischemia time was longer for PPx patients (P < .001). 4.9% and 2.6% of the PPx and NPPx cohorts, respectively, developed postoperative hemorrhagic complications (P = .29). After adjustment for potential covariates, pharmacologic prophylaxis was not associated with 30-day hemorrhagic complications (P = .39). On multivariable regression, longer warm ischemia time (OR 1.05, 95% CI 1.01-1.10, P = .02) and greater tumor size (OR 1.27, 95% CI 1.03-1.56, P = .02) were predictors of hemorrhagic complications. 30-day readmissions, VTE events, and mortality were similar between groups (all P> 0.05). Similar rates of thromboticand bleedingevents occurred between patients receiving pharmacologic prophylaxis and those who did not. Single dose of preoperative enoxaparin did not significantly alter perioperative outcomes after RPNx.