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Introduction: Thromboembolic events are a significant cause of morbidity and mortality after major urological procedures. However, pharmacological thromboembolic prophylaxis (PTP) is often withheld in procedures with a risk of postoperative bleeding such as partial nephrectomy(PN). The goal of this study is to evaluate the safety of administration of PTP at the time of induction of anesthesia immediately prior to PN.
Methods: We performed a retrospective cohort review of all the patients who underwent a PN by a single surgeon between August 2009 and August 2013. We stratified our patients by whether or not they received 5000units of unfractionated heparin (UFH) PTP at the time of induction of anesthesia immediately prior to their PN and compared differences in estimated blood loss (EBL), transfusion rate (TR), complication rate (CR) and length of hospitalization stay (LOS).
Results: A total of152 PN were included(61 open, 91 robotic), 129 (85%) of which received PTP UFH. For the entire cohort, the mean tumor size was 2.7cm (range 1-20), LOS was 3.5days (range 1-15), EBL was 257mL (range 25-1200), and 15 (9.8%) patients required a perioperative blood transfusion while 11 (7%) patients experienced a perioperative complication. Administration of PTP UFH was not associated with a longer LOS (p=0.978), difference in EBL (p=0.855), perioperative TR (p=0.538) or complication rate (p=0.146).
Conclusions: At our institution, the use of PTP did not lead to significant increased risk in EBL, LOS, TR or CR. Surgeons should consider preoperative PTP in patients at high risk for thromboembolic events who are undergoing PN.