Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19111, USA.
J Urol. 2013 Sep;190(3):992-8. doi: 10.1016/j.juro.2013.03.076. Epub 2013 Mar 26.
Thromboprophylaxis with subcutaneous heparin or low molecular weight heparin is now an integral part of national surgical quality and safety assessment efforts, and has been incorporated into the current AUA Best Practice Statement. We evaluated familiarity and compliance with the AUA Best Practice Statement, assessed practice patterns in terms of perioperative thromboprophylaxis and specifically examined self-reported compliance in high risk patients undergoing radical cystectomy.
An electronic survey was sent to AUA members with valid e-mail addresses (10,966). Associations between AUA Best Practice Statement adherence and factors such as urological specialty, graduation year and guideline familiarity were assessed using chi-square analyses and generalized estimating equations.
With 1,210 survey responses the largest group of respondents was urological oncologists and/or laparoscopic/robotic specialists (26.0%). This group was more likely to use thromboprophylaxis than nonurological oncologists and/or laparoscopic/robotic specialists in high risk patients (OR 1.3, CI 1.1-1.5). Respondents aware of the AUA Best Practice Statement guidelines (50.7%) were more likely to use thromboprophylaxis (OR 1.4, CI 1.2-1.6). Although 18.1% of urological oncologists and/or laparoscopic/robotic specialists and 34.2% of nonurological oncologists and/or laparoscopic/robotic specialists avoided routine thromboprophylaxis in patients undergoing radical cystectomy, the former were more likely to use thromboprophylaxis (p <0.0001) than other respondents. Urologists graduating after the year 2000 used thromboprophylaxis in high risk patients undergoing radical cystectomy more often than did earlier graduates (79.2% vs 63.4%, p <0.0001).
Although younger age and self-reported urological oncologist and/or laparoscopic/robotic specialist status correlated strongly with thromboprophylaxis use, self-reported adherence to AUA Best Practice Statement was low, even in high risk cases with clear AUA Best Practice Statement recommendations such as radical cystectomy. These data identify opportunities for quality improvement in patients undergoing major urological surgery.
皮下肝素或低分子肝素的血栓预防现在是国家手术质量和安全评估工作的一个组成部分，并已纳入当前的 AUA 最佳实践声明。我们评估了对 AUA 最佳实践声明的熟悉程度和遵守情况，评估了围手术期血栓预防方面的实践模式，并特别检查了接受根治性膀胱切除术的高危患者的自我报告依从性。
向有有效电子邮件地址的 AUA 会员发送了电子调查（10966 人）。使用卡方分析和广义估计方程评估了 AUA 最佳实践声明遵守情况与泌尿科专业、毕业年份和指南熟悉程度等因素之间的关联。
在 1210 份调查回复中，最大的回复者群体是泌尿科肿瘤学家和/或腹腔镜/机器人专家（26.0%）。与非泌尿科肿瘤学家和/或腹腔镜/机器人专家相比，该组更有可能在高危患者中使用血栓预防（OR 1.3，CI 1.1-1.5）。知晓 AUA 最佳实践声明指南的受访者（50.7%）更有可能使用血栓预防（OR 1.4，CI 1.2-1.6）。尽管 18.1%的泌尿科肿瘤学家和/或腹腔镜/机器人专家和 34.2%的非泌尿科肿瘤学家和/或腹腔镜/机器人专家避免在接受根治性膀胱切除术的患者中常规使用血栓预防，但前者比其他受访者更有可能使用血栓预防（p<0.0001）。2000 年后毕业的泌尿科医生在接受根治性膀胱切除术的高危患者中更频繁地使用血栓预防（79.2%比 63.4%，p<0.0001）。
尽管较年轻的年龄和自我报告的泌尿科肿瘤学家和/或腹腔镜/机器人专家身份与血栓预防的使用密切相关，但自我报告对 AUA 最佳实践声明的遵守率很低，即使在有明确 AUA 最佳实践声明建议的高危病例中，如根治性膀胱切除术。这些数据确定了在接受主要泌尿外科手术的患者中进行质量改进的机会。
