Utilization and outcomes of chemoprophylaxis for the prevention of venous thromboembolism following radical cystectomy: A population-based study.

Abstract

491 Background: 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 Society of Clinical Oncology, American Urological Association, 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 (³10 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: The recommended utilization of chemoprophylaxis in a contemporary nationwide cohort of patients undergoing RC is limited despite its notable increase over the course of the study period. 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.