Venous thromboembolism after nephrectomy

incidence, timing and associated risk factors from a national multi-institutional database

Brian J. Jordan*, Richard S. Matulewicz, Brian Trihn, Shilajit D Kundu

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: To evaluate the rate of venous thromboembolism (VTE) after nephrectomy with specific focus on event timing and location (before or after hospital discharge) in order to identify modifiable risk factors and establish benchmarks for preventive interventions. Methods: Using the ACS-NSQIP database, we identified patients undergoing nephrectomy from 2006 to 2012. Patients were analyzed in two cohorts: collectively and by surgical approach [open vs. lap/robotic (MIS)]. Rates of deep vein thrombosis (DVT) and pulmonary embolus (PE) were assessed and time to each event was established in relation to discharge status. Logistic regression analysis was performed to assess association between preoperative risk factors, surgical variables, and VTE. Results: In total, 13,208 patients met inclusion criteria. The overall rate of VTE was 1.2% (PE = 0.5% and DVT = 0.8, 0.1% DVT and PE). Using regression analysis, diabetes, dependent functional status, and longer operative time were associated with higher odds of DVT. For PE, dyspnea, disseminated cancer, and longer operative time were significant associations. The rate of VTE was higher in open surgery compared to MIS (2 vs. 0.8%, p < 0.001). Median times to DVT and PE were 8.5 and 6 days, respectively, with 53.3% of DVTs and 63.1% of PEs occurring prior to discharge. Conclusions: The overall rate of VTE after nephrectomy is low, occurs roughly one week after surgery, and is associated with longer hospital stays. Certain patient factors, open surgical approach, and longer operative times were associated with higher odds of post-operative VTE; these patients may benefit from more aggressive prophylaxis.

Original languageEnglish (US)
Pages (from-to)1713-1719
Number of pages7
JournalWorld Journal of Urology
Volume35
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Venous Thromboembolism
Nephrectomy
Embolism
Venous Thrombosis
Databases
Incidence
Lung
Operative Time
Regression Analysis
Benchmarking
Robotics
Dyspnea
Length of Stay
Logistic Models
Neoplasms

Keywords

  • Partial nephrectomy
  • Radical nephrectomy
  • Risk factors
  • Venous thromboembolism

ASJC Scopus subject areas

  • Urology

Cite this

@article{fa0e8fda724047f8a66640cba05ad46f,
title = "Venous thromboembolism after nephrectomy: incidence, timing and associated risk factors from a national multi-institutional database",
abstract = "Purpose: To evaluate the rate of venous thromboembolism (VTE) after nephrectomy with specific focus on event timing and location (before or after hospital discharge) in order to identify modifiable risk factors and establish benchmarks for preventive interventions. Methods: Using the ACS-NSQIP database, we identified patients undergoing nephrectomy from 2006 to 2012. Patients were analyzed in two cohorts: collectively and by surgical approach [open vs. lap/robotic (MIS)]. Rates of deep vein thrombosis (DVT) and pulmonary embolus (PE) were assessed and time to each event was established in relation to discharge status. Logistic regression analysis was performed to assess association between preoperative risk factors, surgical variables, and VTE. Results: In total, 13,208 patients met inclusion criteria. The overall rate of VTE was 1.2{\%} (PE = 0.5{\%} and DVT = 0.8, 0.1{\%} DVT and PE). Using regression analysis, diabetes, dependent functional status, and longer operative time were associated with higher odds of DVT. For PE, dyspnea, disseminated cancer, and longer operative time were significant associations. The rate of VTE was higher in open surgery compared to MIS (2 vs. 0.8{\%}, p < 0.001). Median times to DVT and PE were 8.5 and 6 days, respectively, with 53.3{\%} of DVTs and 63.1{\%} of PEs occurring prior to discharge. Conclusions: The overall rate of VTE after nephrectomy is low, occurs roughly one week after surgery, and is associated with longer hospital stays. Certain patient factors, open surgical approach, and longer operative times were associated with higher odds of post-operative VTE; these patients may benefit from more aggressive prophylaxis.",
keywords = "Partial nephrectomy, Radical nephrectomy, Risk factors, Venous thromboembolism",
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Venous thromboembolism after nephrectomy : incidence, timing and associated risk factors from a national multi-institutional database. / Jordan, Brian J.; Matulewicz, Richard S.; Trihn, Brian; Kundu, Shilajit D.

In: World Journal of Urology, Vol. 35, No. 11, 01.11.2017, p. 1713-1719.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Venous thromboembolism after nephrectomy

T2 - incidence, timing and associated risk factors from a national multi-institutional database

AU - Jordan, Brian J.

AU - Matulewicz, Richard S.

AU - Trihn, Brian

AU - Kundu, Shilajit D

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N2 - Purpose: To evaluate the rate of venous thromboembolism (VTE) after nephrectomy with specific focus on event timing and location (before or after hospital discharge) in order to identify modifiable risk factors and establish benchmarks for preventive interventions. Methods: Using the ACS-NSQIP database, we identified patients undergoing nephrectomy from 2006 to 2012. Patients were analyzed in two cohorts: collectively and by surgical approach [open vs. lap/robotic (MIS)]. Rates of deep vein thrombosis (DVT) and pulmonary embolus (PE) were assessed and time to each event was established in relation to discharge status. Logistic regression analysis was performed to assess association between preoperative risk factors, surgical variables, and VTE. Results: In total, 13,208 patients met inclusion criteria. The overall rate of VTE was 1.2% (PE = 0.5% and DVT = 0.8, 0.1% DVT and PE). Using regression analysis, diabetes, dependent functional status, and longer operative time were associated with higher odds of DVT. For PE, dyspnea, disseminated cancer, and longer operative time were significant associations. The rate of VTE was higher in open surgery compared to MIS (2 vs. 0.8%, p < 0.001). Median times to DVT and PE were 8.5 and 6 days, respectively, with 53.3% of DVTs and 63.1% of PEs occurring prior to discharge. Conclusions: The overall rate of VTE after nephrectomy is low, occurs roughly one week after surgery, and is associated with longer hospital stays. Certain patient factors, open surgical approach, and longer operative times were associated with higher odds of post-operative VTE; these patients may benefit from more aggressive prophylaxis.

AB - Purpose: To evaluate the rate of venous thromboembolism (VTE) after nephrectomy with specific focus on event timing and location (before or after hospital discharge) in order to identify modifiable risk factors and establish benchmarks for preventive interventions. Methods: Using the ACS-NSQIP database, we identified patients undergoing nephrectomy from 2006 to 2012. Patients were analyzed in two cohorts: collectively and by surgical approach [open vs. lap/robotic (MIS)]. Rates of deep vein thrombosis (DVT) and pulmonary embolus (PE) were assessed and time to each event was established in relation to discharge status. Logistic regression analysis was performed to assess association between preoperative risk factors, surgical variables, and VTE. Results: In total, 13,208 patients met inclusion criteria. The overall rate of VTE was 1.2% (PE = 0.5% and DVT = 0.8, 0.1% DVT and PE). Using regression analysis, diabetes, dependent functional status, and longer operative time were associated with higher odds of DVT. For PE, dyspnea, disseminated cancer, and longer operative time were significant associations. The rate of VTE was higher in open surgery compared to MIS (2 vs. 0.8%, p < 0.001). Median times to DVT and PE were 8.5 and 6 days, respectively, with 53.3% of DVTs and 63.1% of PEs occurring prior to discharge. Conclusions: The overall rate of VTE after nephrectomy is low, occurs roughly one week after surgery, and is associated with longer hospital stays. Certain patient factors, open surgical approach, and longer operative times were associated with higher odds of post-operative VTE; these patients may benefit from more aggressive prophylaxis.

KW - Partial nephrectomy

KW - Radical nephrectomy

KW - Risk factors

KW - Venous thromboembolism

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