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Perioperative Thromboprophylaxis In A Large Contemporary Prostatectomy Series: Utilization, Efficacy, And Associated Complications
William C. Faust, MD1, Marc Manganiello, MD1, Justin Zbrzezny, MD1, Jonn Humphrey, MD1, Robin Ruthazer, MPH2, Jason Gee, MD1, Andrea Sorcini, MD1, John A. Libertino, MD1, Alireza Moinzadeh, MD1, David Canes, MD1.
1Lahey Clinic, Burlington, MA, USA, 2Tufts Medical School, Boston, MA, USA.
BACKGROUND: Perioperative chemoprophylaxis for radical prostatectomy is controversial given concerns about bleeding and lymphoceles, and AUA guidelines remain vague. We assessed single-center perioperative heparin use, its impact on DVT/PE, and its association with bleeding and lymphocele complications.
METHODS:
We retrospectively reviewed 1490 radical prostatectomies between 2005 and 2010. Perioperative heparin was administered at the surgeon's discretion. Preoperative patient characteristics, pathologic data, heparin use, and complications including blood transfusions, DVT, PE, and incidence of symptomatic lymphocele were recorded.
RESULTS:
The approach to radical prostatectomy was open (31%), laparoscopic (18%) , and robotic (50%). Lymphadenectomy was performed in 485 (32%). Perioperative heparin was administered in 930 (62.4%) while 560 received intermittent pneumatic devices only (37.6%). Twenty-three patients (1.4%) developed DVT/PE. Seventy-five (5.1%) required postoperative blood transfusions. Symptomatic lymphoceles were detected in 23 patients after lymphadenectomy (4.7%). Prior thromboembolic disease, open approach, longer surgical time, and blood loss were associated with an increased risk of thromboembolism (KW-test p 0.0025-0.0081). Perioperative heparin use was associated with decreased risk (OR 0.20 p=0.004). By multivariate logistic regression, heparin was not associated with increased incidence of postoperative bleeding or symptomatic lymphocele (OR 0.99 p=0.98)
CONCLUSIONS:
Post-prostatectomy thrombotic complications were seen in 1.4% of cases, commensurate with other published series. Heparin use was associated with a five-fold decrease in thromboembolic complications; 52 patients need to be treated to prevent one thrombotic complication. Its use did not increase the risk of bleeding or lymphocele formation.
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