This study aimed to test for temporal trends of in-hospital venous thromboembolism (VTE) and pulmonary embolism (PE) after major urologic cancer surgery (MUCS).
In the Nationwide Inpatient Sample (NIS) database (2010-2019), this study identified non-metastatic radical cystectomy (RC), radical prostatectomy (RP), radical nephrectomy (RN), and partial nephrectomy (PN) patients. Temporal trends of VTE and PE and multivariable logistic regression analyses (MLR) addressing VTE or PE, and mortality with VTE or PE were performed.
Of 196,915 patients, 1180 (1.0%) exhibited VTE and 583 (0.3%) exhibited PE. The VTE rates increased from 0.6 to 0.7% (estimated annual percentage change [EAPC] + 4.0%; p = 0.01). Conversely, the PE rates decreased from 0.4 to 0.2% (EAPC - 4.5%; p = 0.01). No difference was observed in mortality with VTE (EAPC - 2.1%; p = 0.7) or with PE (EAPC - 1.2%; p = 0.8). In MLR relative to RP, RC (odds ratio [OR] 5.1), RN (OR 4.5), and PN (OR 3.6) were associated with higher VTE risk (all p < 0.001). Similarly in MLR relative to RP, RC (OR 4.6), RN (OR 3.3), and PN (OR 3.9) were associated with higher PE risk (all p < 0.001). In MLR, the risk of mortality was higher when VTE or PE was present in RC (VTE: OR 3.7, PE: OR 4.8; both p < 0.001) and RN (VTE: OR 5.2, PE: OR 8.3; both p < 0.001).
RC, RN, and PN predisposes to a higher VTE and PE rates than RP. Moreover, among RC and RN patients with either VTE or PE, mortality is substantially higher than among their VTE or PE-free counterparts.
Annals of surgical oncology. 2023 Sep 18 [Epub ahead of print]
Cristina Cano Garcia, Stefano Tappero, Mattia Luca Piccinelli, Francesco Barletta, Reha-Baris Incesu, Simone Morra, Lukas Scheipner, Andrea Baudo, Zhe Tian, Benedikt Hoeh, Francesco Chierigo, Gabriele Sorce, Fred Saad, Shahrokh F Shariat, Luca Carmignani, Sascha Ahyai, Nicola Longo, Derya Tilki, Alberto Briganti, Ottavio De Cobell, Paolo Dell'Oglio, Philipp Mandel, Carlo Terrone, Felix K H Chun, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada. ., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada., Department of Urology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy., Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany., Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, Medical University of Graz, Graz, Austria., Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples Federico II, Naples, Italy., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Ospedale Policlinico San Martino, Genoa, Italy.