Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Urol Focus. 2021 May;7(3):653-658. doi: 10.1016/j.euf.2020.05.015. Epub 2020 Jun 16.
The use of perioperative thromboprophylaxis in urological surgery is common but not standardized.
To characterize international practice variation in thromboprophylaxis use in urological surgery.
DESIGN, SETTING, AND PARTICIPANTS: We conducted a scenario-based survey addressing the use of mechanical and pharmacological thromboprophylaxis in urological cancer procedures (radical cystectomy [RC], radical prostatectomy [RP], and radical nephrectomy [RN]) among practicing urologists in Canada, Finland, and Japan. The survey presented patient profiles reflecting a spectrum of risk for venous thromboembolism; the respondents described their clinical practice.
The proportion of respondents who routinely used (1) mechanical, (2) pharmacological, and (3) extended pharmacological prophylaxis was stratified by procedure. A logistic regression identified characteristics associated with thromboprophylaxis use.
Of 1051 urologists contacted, 570 (54%) participated in the survey. Japanese urologists were less likely to prescribe pharmacological prophylaxis than Canadian or Finnish urologists (p < 0.001 for all procedures). Canadian and Finnish urologists exhibited large variation for extended pharmacological prophylaxis for RP and RN. Finnish urologists were most likely to prescribe extended prophylaxis versus Canadian and Japanese urologists (RC 98%, 84%, and 26%; Open RP 25%, 8%, and 3%; robotic RP 11%, 9%, and 0%; and RN 43%, 7%, and 1%, respectively; p < 0.001 for each procedure). Less variation was found regarding the prescription of mechanical prophylaxis, which was most commonly used until ambulation or discharge. The length of hospital stay was longer in Japan and may bias estimates of extended prophylaxis in Japan.
We found large variation in clinical practice regarding pharmacological thromboprophylaxis within and between countries. Knowledge translation of evidence-based guidelines may reduce problematic international variation in practice.
Use of medications to decrease blood clots after urological cancer surgery differs within and between countries. Closer adherence to urology guidelines addressing the prevention of blood clots may decrease this variation and improve patient outcomes.
围手术期血栓预防在泌尿外科手术中很常见，但尚未标准化。
描述国际上泌尿外科手术中血栓预防的应用情况。
设计、地点和参与者：我们进行了一项基于情景的调查，调查了加拿大、芬兰和日本的泌尿科医生在泌尿外科癌症手术（根治性膀胱切除术[RC]、根治性前列腺切除术[RP]和根治性肾切除术[RN]）中机械和药物血栓预防的应用情况。该调查提供了反映静脉血栓栓塞风险谱的患者概况；受访者描述了他们的临床实践。
根据手术类型，将常规使用（1）机械、（2）药物和（3）延长药物预防的受访者比例进行分层。逻辑回归确定了与血栓预防应用相关的特征。
在联系的 1051 名泌尿科医生中，有 570 名（54%）参与了调查。与加拿大或芬兰泌尿科医生相比，日本泌尿科医生更不可能开药物预防处方（所有手术均为 p < 0.001）。加拿大和芬兰泌尿科医生在 RP 和 RN 的延长药物预防方面存在较大差异。与加拿大和日本泌尿科医生相比，芬兰泌尿科医生更有可能开延长预防处方（RC 98%、84%和 26%；开放式 RP 25%、8%和 3%；机器人 RP 11%、9%和 0%；和 RN 43%、7%和 1%；每个手术均为 p < 0.001）。机械预防的处方差异较小，通常在患者可下床或出院前使用。日本的住院时间较长，可能会影响对日本延长预防的估计。
我们发现，在国家内部和国家之间，药物预防血栓的临床实践存在很大差异。基于证据的指南的知识转化可能会减少实践中的国际问题。
在接受泌尿外科癌症手术后，用于减少血液凝块的药物使用在不同国家和国家之间存在差异。更严格地遵守涉及预防血液凝块的泌尿科指南可能会减少这种差异并改善患者的结果。
