Top

Published in:

01-10-2014 | Original Article

Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy

Authors: Aaron Weinberg, Jason Wright, Christopher Deibert, Yu-Shiang Lu, Dawn Hershman, Alfred Neugut, Benjamin Spencer

Published in: World Journal of Urology | Issue 5/2014

Abstract

Purpose

To examine the practice patterns and predictors of VTE prophylaxis following radical prostatectomy (RP).

Methods

This was a population-based observational study of 94,709 men with a diagnosis of prostate cancer (ICD-9 code 185) who underwent RP were identified from a hospital-based database from 2000 to 2010, including 68,244 (72.1 %) open RP (ORP) and 26,465 (27.9 %) robotic-assisted laparoscopic RP (RALP). VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination.

Results

Following RP, 35,591 (52.2 %) received mechanical, 4,945 (7.2 %) pharmacologic, 7,720 (10.6 %) combination, and 20,438 (30.0 %) no VTE prophylaxis. A total of 245 VTE events (145 DVT, 114 PE) were identified, representing 0.25 % of all procedures. Men with >2 comorbidities (OR = 2.44; 95 % CI 1.78–3.35) and those who were black (OR = 1.44; 95 % CI 1.06–1.97) were more likely to have a VTE. Men who had RALP (OR = 0.61; 95 % CI 0.45–0.99), surgery at high-volume hospitals (OR = 0.45; 95 % CI 0.28–0.73), or received prophylaxis (OR = 0.67; 95 % CI 0.50–0.88) were less likely to develop a VTE.

Conclusion

Despite the observation that VTE prophylaxis reduces the risk of VTE by 40 %, VTE prophylaxis was not used in almost one-third of men who underwent radical prostatectomy.

Guyatt GH, Eikelboom JW, Gould MK et al (2012) Approach to outcome measurement in the prevention of thrombosis in surgical and medical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:185S–194SCrossRef

Kibel AS, Loughlin KR (1995) Pathogenesis and prophylaxis of postoperative thromboembolic disease in urological pelvic surgery. J Urol 153:1763–1774PubMedCrossRef

Zhan C, Miller MR (2003) Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 290:1868–1874PubMedCrossRef

Rossignol G, Leandri P, Gautier JR, Quintens H, Gabay-Torbiero L, Tap G (1991) Radical retropubic prostatectomy: complications and quality of life (429 cases, 1983–1989). Eur Urol 19:186–191PubMed

Brenner DW, Fogle MA, Schellhammer PF (1989) Venous thromboembolism. J Urol 142:1403–1411PubMed

Andriole GL, Smith DS, Rao G, Goodnough L, Catalona WJ (1994) Early complications of contemporary anatomical radical retropubic prostatectomy. J Urol 152:1858–1860PubMed

Heinzer H, Hammerer P, Graefen M, Huland H (1998) Thromboembolic complication rate after radical retropubic prostatectomy. Impact of routine ultrasonography for the detection of pelvic lymphoceles and hematomas. Eur Urol 33:86–90PubMedCrossRef

Dillioglugil O, Leibman BD, Leibman NS, Kattan MW, Rosas AL, Scardino PT (1997) Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 157:1760–1767PubMedCrossRef

Zincke H, Oesterling JE, Blute ML, Bergstralh EJ, Myers RP, Barrett DM (1994) Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol 152:1850–1857PubMed

10.

Geerts WH, Pineo GF, Heit JA et al (2004) Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:338S–400SPubMedCrossRef

11.

Secin FP, Jiborn T, Bjartell AS et al (2008) Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 53:134–145PubMedCrossRef

12.

Galvin DJ, Mulvin D, Quinlan DM (2004) Thromboprophylaxis for radical prostatectomy: a comparative analysis of present practice between the USA, the UK, and Ireland. Prostate 60:338–342PubMedCrossRef

13.

Montorsi F, Wilson TG, Rosen RC et al (2012) Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena consensus panel. Eur Urol 62:368–381PubMedCrossRef

14.

Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin EM, Auerbach AD (2007) Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med 357:2589–2600PubMedCrossRef

15.

Rothberg MB, Pekow PS, Lahti M, Brody O, Skiest DJ, Lindenauer PK (2010) Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 303:2035–2042PubMedCrossRef

16.

Wright JD, Ananth CV, Lewin SN et al (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309:689–698PubMedCrossRef

17.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef

18.

Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRef

19.

Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245:777–783PubMedCrossRefPubMedCentral

20.

Cisek LJ, Walsh PC (1993) Thromboembolic complications following radical retropubic prostatectomy. Influence of external sequential pneumatic compression devices. Urology 42:406–408PubMedCrossRef

21.

Collins R, Scrimgeour A, Yusuf S, Peto R (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 318:1162–1173PubMedCrossRef

22.

Hu JC, Gu X, Lipsitz SR et al (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302:1557–1564PubMedCrossRef

23.

Williams SB, Prasad SM, Weinberg AC et al (2011) Trends in the care of radical prostatectomy in the United States from 2003 to 2006. BJU Int 108:49–55PubMedCrossRef

24.

Wright JD, Lewin SN, Shah M et al (2011) Quality of venous thromboembolism prophylaxis in patients undergoing oncologic surgery. Ann Surg 253:1140–1146PubMedCrossRef

25.

Khorana AA, Streiff MB, Farge D et al (2009) Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action. J Clin Oncol 27:4919–4926PubMedCrossRefPubMedCentral

26.

Scarpa RM, Carrieri G, Gussoni G et al (2007) Clinically overt venous thromboembolism after urologic cancer surgery: results from the @RISTOS study. Euro Urol 51:130–135; discussion 6

27.

Caprini JA, Arcelus JI, Reyna JJ (2001) Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol 38:12–19PubMedCrossRef

28.

Williams SB, Amarasekera CA, Gu X et al (2012) Influence of surgeon and hospital volume on radical prostatectomy costs. J Urol 188:2198–2202PubMedCrossRef

29.

Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS (2003) Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 21:401–405PubMedCrossRef

30.

Patel T, Kirby W, Hruby G, Benson MC, McKiernan JM, Badani K (2011) Heparin prophylaxis and the risk of venous thromboembolism after robotic-assisted laparoscopic prostatectomy. BJU Int 108:729–732PubMedCrossRef

Title: Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy
Authors: Aaron Weinberg
Jason Wright
Christopher Deibert
Yu-Shiang Lu
Dawn Hershman
Alfred Neugut
Benjamin Spencer
Publication date: 01-10-2014
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 5/2014
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-013-1212-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2014

Nocturia and its impact on health-related quality of life and health care seeking behaviour in German community-dwelling men aged 50 years or older

Adipose-derived stem cells (ADSCs) and muscle precursor cells (MPCs) for the treatment of bladder voiding dysfunction

Detrusor contraction power parameters (BCI and W max) rise with increasing bladder outlet obstruction grade in men with lower urinary tract symptoms: results from a urodynamic database analysis

Is real-time PCR the correct method to evaluate the incidence of human papillomavirus in prepuces of asymptomatic boys and men?

New developed urological protocols for the Uro Dyna-CT reduce radiation exposure of endourological patients below the levels of the low dose standard CT scans

Is there a volume–outcome relationship for partial nephrectomy?