156 Nationwide Practice Patterns for the Use of Venous Thromboembolism Prophylaxis Among Men Undergoing Radical Prostatectomy

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness (II)1 Apr 2013156 NATIONWIDE PRACTICE PATTERNS FOR THE USE OF VENOUS THROMBOEMBOLISM PROPHYLAXIS AMONG MEN UNDERGOING RADICAL PROSTATECTOMY Aaron Weinberg, Jason Wright, Yu-Shiang Lu, Christopher Deibert, Dawn Hershman, Al Neugut, Mitchell Benson, and Benjamin Spencer Aaron WeinbergAaron Weinberg New York, NY More articles by this author , Jason WrightJason Wright New York, NY More articles by this author , Yu-Shiang LuYu-Shiang Lu New York, NY More articles by this author , Christopher DeibertChristopher Deibert New York, NY More articles by this author , Dawn HershmanDawn Hershman New York, NY More articles by this author , Al NeugutAl Neugut New York, NY More articles by this author , Mitchell BensonMitchell Benson New York, NY More articles by this author , and Benjamin SpencerBenjamin Spencer New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1536AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer patients undergoing radical prostatectomy (RP) are at higher risk for venous thromboembolism (VTE). Robotic surgery may confer an even greater risk. Evidence-based guidelines recommend both mechanical and pharmacologic prophylaxis during the perioperative period. It is unknown whether these guidelines are being followed. METHODS Prostate cancer patients who underwent RP from 2000-10 were analyzed from the Perspective database. VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination. We used generalized estimating equations to investigate the influence of patient, surgeon and hospital characteristics on VTE prophylaxis use and VTE. RESULTS We identified 94,709 men who underwent RP, including 28% robotic. Mechanical, pharmacologic, and combination prophylaxis were received by 49%, 10% and 13%, respectively. Prophylaxis use was stable throughout the study period, except combination, which increased from 11% to 14%. Use of prophylaxis was not related to year of surgery, patient demographics, hospital factors, or surgical volume by hospital or surgeon. However, there was a trend toward increased use in robotic surgeries (OR 1.53, p=0.07). VTE was identified in 0.25% and was more likely to occur in men with greater comorbidities (OR 2.43, p<0.01), but less likely to occur in men who underwent robotic RP (OR 0.65, p=0.03 vs. open) and those that had mechanical prophylaxis (OR 0.63, p=0.01 vs. none). Pharmacologic prophylaxis trended toward reducing VTE (OR 0.75, p=0.08 vs. none). CONCLUSIONS This study represents the first nationwide examination of VTE prophylaxis practice patterns in men undergoing RP. Despite guidelines recommending its use, VTE prophylaxis was used in only 28% of patients. The use of mechanical prophylaxis was protective against VTE. Large prospective trials to better define the optimal VTE prophylaxis regimen are warranted. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e64 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Weinberg New York, NY More articles by this author Jason Wright New York, NY More articles by this author Yu-Shiang Lu New York, NY More articles by this author Christopher Deibert New York, NY More articles by this author Dawn Hershman New York, NY More articles by this author Al Neugut New York, NY More articles by this author Mitchell Benson New York, NY More articles by this author Benjamin Spencer New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...