EAU 2018: Utilization and Outcomes of Chemoprophylaxis for the Prevention of Venous Thromboembolism Following Radical Cystectomy: A Population-Based Study
Reese et al. aimed to evaluate the chemoprophylaxis usage patterns throughout the U.S. following RC using the Premier Hospital Database, a nation-wide quality improvement database with information relevant for studying patient outcomes following surgery and hospitalization. >30,000 patients were analyzed, which is a remarkable cohort size to study. Adherence was defined as chemoprophylaxis initiated within 24hrs postoperatively, and use was monitored until discharge from the hospital. No information was available regarding outpatient administration of chemoprophylaxis, which would be considered full standard of care.
They found that the utilization of VTE prophylaxis increased from 21% in 2006 to 49.6% in 2015. Shockingly, this well-accepted prophylactic measure was used <50% of the time by 2015, a year by which the benefits of chemoprophylaxis following major pelvic surgery was well known. The authors did analyze adverse events in hospitals that never used chemoprophylaxis vs. those that always used chemoprophylaxis, and found lower rates of VTE and PE with the use of chemoprophylaxis, but also higher bleeding rates in these patients. Bleeding is clearly the fear that likely causes some surgeons to withhold anticoagulation postoperatively, but these bleeding fears have not consistently been shown to have merit in prospective studies.
Immediate postoperative chemoprophylaxis followed by extended outpatient chemoprophylaxis should be standard of care for all eligible patients undergoing RC. The finding that <50% of patients are started on chemoprophylaxis immediately after surgery should raise alarm bells for the field of Urology. Postoperative chemoprophylaxis is a basic quality measure that needs to permeate into every hospital performing these high-risk surgeries; and one would hope that utilization rates are much closer to 100% by the next time these data are analyzed.
Presented by: Reese S. Brigham and Women's Hospital, Dept. of Urologic Surgery, Boston, United States of America
Co-Authors: Zlatev D. , Reese S. , Mossanen M. , Pucheril D. , Chang S.
Written by: Shreyas Joshi, MD, Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark.