Preoperative Incidence of Deep Venous Thrombosis in Patients With Bladder Cancer Undergoing Radical Cystectomy

• Published in: Urology (Ridgewood, N.J.) N.J.), 2018-06, Vol.116, p.120-124
• Main Authors: Schomburg, John L., Krishna, Suprita, Cotter, Katherine J., Soubra, Ayman, Rao, Amrita, Konety, Badrinath R.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cystectomy - adverse effects; Female; Humans; Incidence; Lower Extremity - blood supply; Male; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Period; Prospective Studies; Risk Factors; Severity of Illness Index; Ultrasonography, Doppler, Duplex; Urinary Bladder - pathology; Urinary Bladder - surgery; Urinary Bladder Neoplasms - surgery; Venous Thromboembolism - diagnosis; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Venous Thrombosis - complications; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - epidemiology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2018.01.052

To determine the preoperative incidence of subclinical lower-extremity deep vein thrombosis (DVT), as well as to evaluate the utility of preoperative DVT screening in patients with bladder cancer before 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 before 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 lower-extremity duplex ultrasound positive screening. 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 before 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 = .008). Postoperatively, there was a nonsignificant trend of lower DVT rate in the screened group compared to historical control. Overall complication rate and severity were similar between the groups. Subclinical DVT is present in a significant number of pre-cystectomy patients, especially those exposed to neoadjuvant chemotherapy. Ultrasound screening in patients before undergoing radical cystectomy may identify opportunities for early intervention to reduce morbidity and mortality associated with perioperative DVT or venous thromboembolism in the cystectomy population.