Elderly patients undergoing laparoscopic radical cystectomy benefit from dynamic D-dimer measurement in combination with vascular ultrasonography: reduction of VTE risk and improvement of clinical outcomes.

BACKGROUND

Venous thromboembolism (VTE) is serious in elderly patients undergoing laparoscopic radical cystectomy and bilateral pelvic lymph node dissection. We compared the results of two VTE prophylaxis protocols: dynamic D-dimer measurement in combination with ultrasonography screening in Experimental Group (EG), and conventional VTE prophylaxis in historical control group (HCG).

METHODS

Between January 2022 and January 2024, the elderly patients undergoing such surgeries in EG received dynamic measurement of plasma D-dimer at admission and at 1, 3, 7, and 14 days after surgery in combination with ultrasonography screening, and commensurate VTE mechanical prophylaxis measures. Between January 2019 and December 2021, elderly patients in HCG underwent conventional prophylaxis and mechanical measures. And they were observed carefully for VTE symptoms, with Doppler ultrasonography being performed only in patients with clinical suspicion for VTE. The incidence of VTE event, major postoperative complications, major bleeding rate, and evaluation of activities of daily living within 30 days postoperatively were compared.

RESULTS

The preoperative and intraoperative parameters were similar between the two groups. In EG, dynamic D-dimer measurements revealed a distinct temporal declining pattern. In HCG, VTE was detected in five patients out of 98 patients (5/98, 4.08%); and in EG, eight patients were found to have DVT (8/109, 7.34%; = 0.04). The incidence of symptomatic VTE was significantly lower in EG than in HCG (one and five cases, respectively, 0.9% vs. 5.1%, = 0.04), and the incidence of postoperative asymptomatic VTE was higher in the EG than in the HCG (seven and 0 cases, respectively, 6.4% vs. 0%). The incidence of major complications was similar between the two groups ( = 0.61), with similar result regarding the incidence of major bleeding ( = 0.55). The average Barthel index score in EG was 81.0 points, significantly higher than 78.3 points of the HCG ( = 0.03), and the result demonstrated a faster recovery of activities of daily living in the Experimental Group.

CONCLUSION

Our results demonstrated that postoperative dynamic D-dimer and ultrasonography measurement in elderly patients can better monitor the risk of VTE, identify asymptomatic thrombosis at an early stage, optimize the timing of intervention and improve clinical outcomes, without resulting in more complications or major bleeding. Elderly patients undergoing laparoscopic radical cystectomy could benefit from such strategies.