Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery: Systematic Review and Meta-analysis

Tikkinen, Kari A.O.; Craigie, Samantha; Agarwal, Arnav; Violette, Philippe D.; Novara, Giacomo; Cartwright, Rufus; Naspro, Richard; Siemieniuk, Reed A C; Ali, Bassel; Eryuzlu, Leyla; Geraci, Johanna; Winkup, Judi; Yoo, Daniel; Gould, Michael K.; Sandset, Per Morten; Guyatt, Gordon

doi:10.1016/j.eururo.2017.02.025

Cited by 79 publications

(59 citation statements)

References 17 publications

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“…In the 1990s, when anticoagulation treatment for inpatients was not mature, some studies showed the incidence of VTE was in the range of 10-30% for hospitalized patients and interestingly the non-surgical inpatients suffering more deaths than surgical inpatients [9,10]. Recently, our previous research and other literatures have demonstrated that VTE event is not rare in non-oncological urology which can be associated with signi cant higher rate of intensive care hospital transfer, longer inpatient recover, more medical costs, and more mortality [6,11]. So early diagnosis of VTE can prevent a lot of troubles for human and sociaty because VTE is a preventable disease.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is not enough high-quality evidence, the incidence of VTE in non-tumor surgery in urology is not as low as we think. For the major urological surgeries, the incidence of VTE varies from 0.3-10.8%, especially high in open recipient nephrectomy and open simple prostatectomy whose incidence is 1.3-5.3% and 2.7-10.8%, respectively [6]. Therefore, more attention should be paid to non-oncological patients in surgical departments.…”

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confidence: 99%

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Establishment of Prediction Models for venous thromboembolism in non-oncological urological inpatients--a single center experience

Zhu

et al. 2020

Preprint

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Background To establish prediction models for venous thromboembolism (VTE) in non-oncological urological inpatients. Methods A retrospective analysis of 1453 inpatients was carried out and the risk factors for VTE had been clarified our previous studies. Results Risk factors included the following 5 factors: presence of previous VTE (X1), presence of anticoagulants or anti-platelet agents treatment before admission (X2), D-dimer value (≥ 0.89 µg/ml, X3), presence of lower extremity swelling (X4), presence of chest symptoms (X5). The logistic regression model is Logit (P) = − 5.970 + 2.882 * X1 + 2.588 * X2 + 3.141 * X3 + 1.794 * X4 + 3.553 * X5. When widened the p value to not exceeding 0.1 in multivariate logistic regression model, two addition risk factors were enrolled: Caprini score (≥ 5, X6), presence of complications (X7). The prediction model turns into Logit (P) = − 6.433 + 2.696 * X1 + 2.507 * X2 + 2.817 * X3 + 1.597 * X4 + 3.524 * X5 + 0.886 * X6 + 0.963 * X7. Internal verification results suggest both two models have a good predictive ability, but the prediction accuracy turns to be both only 43.0% when taking the additional 291 inpatients’ data in the two models. Conclusion We built two similar novel prediction models to predict VTE in non-oncological urological inpatients. Trial registration: This trial was retrospectively registered at http://www.chictr.org.cn/index.aspx under the public title“The incidence, risk factors and establishment of prediction model for VTE n urological inpatients” with a code ChiCTR1900027180 on November 3, 2019. (Specific URL to the registration web page: http://www.chictr.org.cn/showproj.aspx?proj=44677).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Establishment of Prediction Models for venous thromboembolism in non-oncological urological inpatients--a single center experience

Zhu

et al. 2020

Preprint

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“…Guidelines are available to facilitate evidence-based use of thromboprophylaxis after surgery. 8,9 In 2012, the American College of Chest Physicians published a landmark article on thromboprophylaxis after non-orthopedic surgery. 8 This guideline suggested thromboprophylaxis use should be based on risk stratification using the Caprini score.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, thromboprophylaxis guidelines in urology have been published that are procedure specific and provide recommendations based on the procedure type and patient risk factors. 9 For this study, we hypothesized that all abdominopelvic procedures frequently performed for cancer would be associated with VTE risk, independent of Caprini score.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism and transfusion after major abdominopelvic surgery

McAlpine

Breau

Knee

et al. 2019

Surgery

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Background: Thromboprophylaxis aims to reduce venous thromboembolism but has the potential to increase bleeding. We sought to evaluate the risk of venous thromboembolism and transfusion after major abdominopelvic procedures and to quantify the association of the procedure with venous thromboembolism. Methods: The American College of Surgeons' National Surgical Quality Improvement Program was queried for patients who received an abdominopelvic surgery between 2005 and 2016. Patient factors, operative factors, and outcomes were collected. Multivariable analyses were used to determine the association between individual procedures and venous thromboembolism. Area under the curve analyses were performed to assess whether addition of the procedure to Caprini score improved the association of the model with venous thromboembolism. The primary outcome was risk of venous thromboembolism within 30 days of surgery. Secondary outcomes were the risk of transfusion within 30 days and the association between operative time with venous thromboembolism. Results: There were 896,441 patients who received an abdominopelvic procedure. The overall risk of venous thromboembolism was 1.9% (n ¼ 16,665). Procedures with the highest risk of venous thromboembolism were esophagectomy (5.5%) and partial esophagectomy (5.3%). The overall risk of transfusion was 9.5% (n ¼ 84,889). Procedures with the highest risk of transfusion were pelvic exenteration (53.6%) and radical cystectomy (37.7%). On multivariable analyses, individual procedures were independently associated with venous thromboembolism, despite adjusting for Caprini score. Area under the curve analyses indicated risk prediction of the baseline model (area under the curve 0.59) improved when procedures were added (area under the curve 0.68). Conclusion: Patients undergoing abdominopelvic surgery are at a high risk of venous thromboembolism and transfusion. Improved risk stratification may be possible by including more procedural information in scoring systems.

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“…In 2012, the American College of Chest Physicians (ACCP) published landmark guidelines on venous thromboprophylaxis following non-orthopedic operations (5). This publication was the best recognized guide for VTE prophylaxis following abdominal and pelvic surgery (including urological surgery) prior to the recently published European Association of Urology (EAU) procedure-specific guidelines (6). It is plausible that some of the improvements in VTE rates observed in this study are attributable to a change in practice patterns and the uptake of extended duration thromboprophylaxis following this publication.…”

mentioning

confidence: 99%

Decreasing rates of venous thromboembolism after radical cystectomy: an encouraging trend and more work is still needed

McAlpine

Lavallée

2018

Transl. Androl. Urol

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Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery: Systematic Review and Meta-analysis

Cited by 79 publications

References 17 publications

Establishment of Prediction Models for venous thromboembolism in non-oncological urological inpatients--a single center experience

Establishment of Prediction Models for venous thromboembolism in non-oncological urological inpatients--a single center experience

Venous thromboembolism and transfusion after major abdominopelvic surgery

Decreasing rates of venous thromboembolism after radical cystectomy: an encouraging trend and more work is still needed

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