Predictive accuracy of boosted regression model in estimating risk of venous thromboembolism following laparoscopic radical surgery in pharmacological prophylaxis-naïve men with prostate cancer

Abstract

Background Venous thromboembolism (VTE) is a potentially life-threatening but preventable complication after urological surgery. Physicians are faced with challenges of weighing the risks and benefits of thromboprophylaxis given scanty evidence for or against and practice variation worldwide. Objective The primary objective of the study was to explore the possibility of a risk-stratified approach for thromboembolism prophylaxis following radical prostatectomy. Design, setting and participants: A prospective database was accessed to cross-link venous thromboembolism events in 522 men who underwent minimally invasive prostatectomy between February 2010 to October 2021. A deterministic data linkage method was used to record events through electronic systems. Community Health Index (CHI) numbers were used to identify patients via the electronic health records. Patient demographics and clinical characteristics such as age, comorbidities, Gleason staging, and readmission details accrued. Outcomes VTE within 30 days and development of risk-stratified scoring system. All statistical analysis was performed using R-Statistical Software and risk of VTE within 30 days of surgery was estimated via gradient-boosting decision trees (BRT) model. Results and limitations: 1.1% (6/522) of patients developed deep veins thrombosis or pulmonary embolism within 3-months post-minimally invasive prostatectomy. Statistical analysis demonstrated a significant difference in the body-mass-index (p = 0.016), duration of hospital stay (p < 0.001), number of readmissions (p = 0.036) between patients who developed VTE versus patients who did not develop VTE. BRT analysis found 8 variables which demonstrated relative importance in predicting VTE. The receiver operating curves (ROC) was constructed to assess the discrimination power of new model. Model showed an AUC of 0.97 (95% confidence intervals [CI]: 0.945,0.999). for predicting VTE. Single centre study is a limitation Conclusions The incidence of VTE post-minimally invasive prostatectomy in men who did not receive prophylaxis with low molecular weight heparin is low (1.1%). The proposed risk scoring system may aid in identification of higher risk patients for thromboprophylaxis.