To determine the pre-operative incidence of subclinical lower-extremity deep vein thrombosis (DVT), as well as to evaluate the utility of preoperative DVT screening in bladder cancer patients prior to undergoing radical cystectomy.
Beginning in 2014, we prospectively instituted a policy of obtaining a screening lower-extremity duplex ultrasound on all patients within 7 days prior to undergoing radical cystectomy. We reviewed the electronic medical records of all patients at our institution who underwent radical cystectomy for bladder cancer from January 2012 through December 2015. The screened group (n = 65) underwent preoperative screening; the historical control group (n = 78) did not. Primary outcome was a positive screening lower-extremity duplex ultrasound. Secondary outcome measures included the development of symptomatic venous thromboembolism (VTE) postoperatively, and the rate and severity of complications.
DVT was identified in 13.9% of patients prior to undergoing cystectomy. Univariate analysis demonstrated an increased risk of subclinical DVT in patients who were exposed to neoadjuvant chemotherapy (35.3% vs 5.1%, p=0.008). Post-operatively, there was a non-significant trend of lower DVT rate in the screened group compared to historical control. Overall complication rate and severity were similar between groups.
Subclinical DVT is present in a significant number of pre-cystectomy patients, especially those exposed to neoadjuvant chemotherapy. Screening ultrasound in patients prior to undergoing radical cystectomy may identify opportunities for early intervention to reduce morbidity and mortality associated with perioperative DVT/VTE in the cystectomy population.
Urology. 2018 Mar 15 [Epub ahead of print]
John L Schomburg, Suprita Krishna, Katherine J Cotter, Ayman Soubra, Amrita Rao, Badrinath Konety
University of Minnesota Department of Urology., University of Minnesota Department of Urology. Electronic address: .