Preoperative risk factors for venous thromboembolism in major urologic cancer surgeries

Venous thromboembolism (VTE) is a serious complication of urologic cancer surgeries. Incidence varies by procedure, with cystectomy carrying the highest risk. Our study aims to explore the preoperative risk factors for VTE development in major urologic cancer surgeries.

Using the ACS-NSQIP database, cystectomy, prostatectomy or nephrectomy cases between 2011 and 2020 were identified. Patient characteristics and pre-operative variables were compared using χ2 test. Multivariate logistic regression was used to control for confounding variables.

207,861 patients were included. 2484 (1.2%) patients experienced VTE post-operatively, with a rate of 3.16% among cystectomy patients. The incidence of pulmonary embolism (PE) peaked at day 2, while that of deep venous thrombosis (DVT) peaked at days 2 and 8. On multivariate analysis, blood transfusion and cystectomy were associated with the highest risk of VTE (OR = 2.29 [1.64, 3.18], P = < 0.001 and OR = 2.96, 95%CI [2.62, 3.37], P < 0.0001; respectively). Other important risk factors included advanced age ≥ 80 years (OR = 1.98 [1.65, 2.40], P = 0.001), BMI ≥ 40 kg/m2 (OR = 1.82 [1.43, 2.24], P = 0.001), congestive heart failure (OR = 1.75 [1.15, 2.66], P = 0.008), steroid use (OR = 1.55 [1.26, 1.94], P = < 0.001), thrombocytosis OR = 1.43 [1.16, 1.76], P = 0.001) and leukocytosis (OR = 1.41 [1.11, 1.54], P = < 0.001).

Our study highlights important pre-operative risk factors for the development of VTE after urologic cancer surgeries. This stresses the importance of pre-operative risk assessment to guide counseling and thromboprophylaxis strategies especially among cystectomy patients who are older, obese, and requiring blood transfusion.