| Perioperative Clinical Thromboembolic Events after Radical or Partial Nephrectomy |
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| Written by Christopher G. Wood, MD | ||
| Friday, 09 March 2007 | ||
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BERKELEY, CA (UroToday.com) - Pulmonary embolus can be a devastating complication associated with any surgical endeavor. Much of the literature surrounding the incidence and prophylaxis for thromboembolic phenomena comes from the general surgery literature, with little published specifically regarding urologic procedures. The incidence is increased in the elderly, those with cancer, and those undergoing abdominal or pelvic surgical procedures. Little has been reported on the incidence of thromboembolic events following renal surgery such that no uniform recommendations for prophylaxis exist in the literature. Here, Pettus and colleagues out of Memorial Sloan Kettering report on the incidence of thromboembolic events following renal surgery, with the identification of factors that might predict increased risk and therefore guide institution of more aggressive prophylaxis.The authors report on 2208 patients who underwent radical or partial nephrectomy over a 16 year period at their institution. There were 34 thromboembolic events (deep venous thrombosis (DVT) or pulmonary embolus (PE)) in 33 patients for a rate of 1.5%. All patients in this series underwent routine prophylaxis with pneumatic compression devices in the perioperative period. Of note, the operative approach (radical versus partial, open versus laparoscopic) did not influence the rate of thromboembolic phenomena. Risk factors for DVT included the presence of coronary artery disease (p=0.050) and increased patient age (p=0.020). Patients with DVT were more likely to have non-organ confined disease. Risk factors for the development of a PE included a history of cardiac arrhythmia (p=0.02), history of prior DVT (p=0.053), and increased blood loss at surgery (p=0.001). The odds ratio for PE increased by 1.025 for every 100 ml of blood lost at the time of surgery. Increased operative time as a risk factor for thromboembolic phenomena approached significance (p=0.06). This study demonstrates that while the incidence of thromboembolic phenomena is low in patients undergoing renal surgery, there are specific subsets of patients that can be identified that are at increased risk and therefore deserving of more aggressive prophylaxis. These include older patients, those with a history of cardiac disease, those with a history of prior DVT, and those who have increased blood loss at the time of surgery. Prophylactic anticoagulation might be considered in addition to pneumatic compression groups in these specific subpopulations. Pettus JA, Eggener SE, Shabsigh A, Yanke B, Snyder ME, Serio A, Vickers A, Russo P, Donat SM
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