Mp23-11 do No Harm: The Role of Perioperative Heparin in Anterior Urethroplasty

Abstract

INTRODUCTION AND OBJECTIVE: Venous thromboembolism (VTE) is a perioperative complication with significant morbidity. Routine use of peri-operative VTE prophylaxis is common guideline-driven practice across multiple surgical specialties. There is a discrepancy between guideline recommendations and clinical practice in the administration of peri-operative heparin for anterior urethroplasty. The purpose of this study was to examine the necessity of peri-operative heparin in patients undergoing anterior urethroplasty.METHODS: Patients were identified from an IRB-approved, prospectively maintained database of patients undergoing anterior urethral reconstruction by a single surgeon at MedStar Washington Hospital Center (MWHC) from 2012-2020. All patients had sequential compression devices (SCDs) prior to anesthesia induction. Patients received heparin based on hospital policy as dual prophylaxis. Primary endpoint was perioperative VTE within 30 days with secondary outcomes of peri-operative complications and stricture recurrence.RESULTS: We identified 342 patients who met inclusion criteria. 68 patients received peri-operative heparin. One patient had a DVT in the SCD only group. There were statistically significant increases in hospital length of stay, stricture recurrence, and postoperative complications in the group that received heparin.CONCLUSIONS: Routine heparin administration likely overtreats men undergoing anterior urethroplasty. There may be a subset of men in whom dual prophylaxis with heparin and SCD is beneficial for prevention of VTE. Currently guidelines do not offer adequate criteria to identify these men. We offer an algorithm to help guide further study to identify these patients.