Risk of Post-Operative Venous Thromboembolism in Urethroplasty
Matthew J. Moynihan, MD, MPH; Alex J. Vanni, MD
Lahey Clinic, Burlington, MA
BACKGROUND: The prevention of venous thromboembolism (VTE) and reducing its significant morbidity and mortality is of utmost importance for the urologic surgeon, and has been an initiative across multiple surgical specialties and organizations including the American Urological Association (AUA), the Centers for Medicine and Medicinal Services, and the Joint Commission on Accreditation of Health Care Organizations. The European Association of Urology (EAU) has recently published the first urologic specific guideline on thromboprophylaxis for VTE, but there was insufficient data to provide a recommendation on chemoprophylaxis to prevent VTE with regards to urethroplasty. The aim of this study is to provide urethroplasty procedure specific data on the risk of VTE and postoperative bleeding in patients undergoing urethroplasty.
METHODS: We retrospectively analyzed a prospectively maintained, multi-institutional database of 10 institutions. Patient demographics, co-morbid conditions, operative characteristics, occurrence of post-operative VTE (deep venous thrombosis or pulmonary embolism), and prevalence of post-operative bleeding complications were analyzed. Comparisons between groups were performed using standard Chi-squared and t-tests where appropriate.
RESULTS: A total of 2,991 urethroplasties were reviewed over a period from 2006-2017. A diagnosis of VTE was found in 9 (0.3%) of cases. Patients who had a post-operative VTE were significantly more likely to have higher BMI (36.1 vs 29.8, p=0.0064) and higher time in lithotomy position (302.2 vs 186.8, p=0.0014). Patients in the VTE group were also more likely to have coronary artery disease (RR 4.2, p=0.1737) and have a history of malignancy (RR 4.1, p=0.0463). Those patients without DVT had a higher rate of post-operative hematomas (RR 3.3, p=0.4083).
CONCLUSIONS: This is the largest study to date evaluating the risk of VTE in patients undergoing urethroplasty. Patients with high BMI, extended time in lithotomy position, and history of malignancy are at greater risk for development of a DVT after urethroplasty. However, the risk of VTE in the majority of patients undergoing urethroplasty is very low and thus patients may not require chemoprophylaxis for VTE prevention.
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