Najdi Jad, Ayoub Christian Habib, Chawareb Elia Abou, El Baba Bachar, Malik Eva, El-Hajj Albert
Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
American University of Beirut Medical Center Riad El-Solh, Beirut, 1107 2020, Lebanon.
World J Urol. 2024 Dec 4;43(1):10. doi: 10.1007/s00345-024-05372-9.
Venous thromboembolism (VTE) is a serious complication of urologic cancer surgeries. Incidence varies by procedure, with cystectomy carrying the highest risk. Our study aims to explore the preoperative risk factors for VTE development in major urologic cancer surgeries.
Using the ACS-NSQIP database, cystectomy, prostatectomy or nephrectomy cases between 2011 and 2020 were identified. Patient characteristics and pre-operative variables were compared using χ2 test. Multivariate logistic regression was used to control for confounding variables.
207,861 patients were included. 2484 (1.2%) patients experienced VTE post-operatively, with a rate of 3.16% among cystectomy patients. The incidence of pulmonary embolism (PE) peaked at day 2, while that of deep venous thrombosis (DVT) peaked at days 2 and 8. On multivariate analysis, blood transfusion and cystectomy were associated with the highest risk of VTE (OR = 2.29 [1.64, 3.18], P = < 0.001 and OR = 2.96, 95%CI [2.62, 3.37], P < 0.0001; respectively). Other important risk factors included advanced age ≥ 80 years (OR = 1.98 [1.65, 2.40], P = 0.001), BMI ≥ 40 kg/m2 (OR = 1.82 [1.43, 2.24], P = 0.001), congestive heart failure (OR = 1.75 [1.15, 2.66], P = 0.008), steroid use (OR = 1.55 [1.26, 1.94], P = < 0.001), thrombocytosis OR = 1.43 [1.16, 1.76], P = 0.001) and leukocytosis (OR = 1.41 [1.11, 1.54], P = < 0.001).
Our study highlights important pre-operative risk factors for the development of VTE after urologic cancer surgeries. This stresses the importance of pre-operative risk assessment to guide counseling and thromboprophylaxis strategies especially among cystectomy patients who are older, obese, and requiring blood transfusion.
静脉血栓栓塞症（VTE）是泌尿外科癌症手术的严重并发症。发病率因手术方式而异，膀胱切除术的风险最高。我们的研究旨在探讨泌尿外科主要癌症手术中VTE发生的术前危险因素。
利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，确定2011年至2020年间的膀胱切除术、前列腺切除术或肾切除术病例。使用χ2检验比较患者特征和术前变量。采用多因素逻辑回归控制混杂变量。
共纳入207,861例患者。2484例（1.2%）患者术后发生VTE，膀胱切除术患者的发生率为3.16%。肺栓塞（PE）的发生率在术后第2天达到峰值，而深静脉血栓形成（DVT）的发生率在术后第2天和第8天达到峰值。多因素分析显示，输血和膀胱切除术与VTE的最高风险相关（OR = 2.29 [1.64, 3.18]，P = < 0.001；OR = 2.96，95%CI [2.62, 3.37]，P < 0.0001）。其他重要危险因素包括年龄≥80岁（OR = 1.98 [1.65, 2.40]，P = 0.001）、体重指数（BMI）≥40 kg/m2（OR = 1.82 [1.43, 2.24]，P = 0.001）、充血性心力衰竭（OR = 1.75 [1.15, 2.66]，P = 0.008）、使用类固醇（OR = 1.55 [1.26, 1.94]，P = < 0.001）、血小板增多症（OR = 1.43 [1.16, 1.76]，P = 0.001）和白细胞增多症（OR = 1.41 [1.11, 1.54]，P = < 0.001）。
我们的研究强调了泌尿外科癌症手术后VTE发生的重要术前危险因素。这突出了术前风险评估对于指导咨询和血栓预防策略的重要性，尤其是在年龄较大、肥胖且需要输血的膀胱切除术患者中。
