Surgical operative time increases the risk of deep venous thrombosis and pulmonary embolism in robotic prostatectomy

E Jason Abel, Kelvin Wong, Martins Sado, Glen E Leverson, Sutchin R Patel, Tracy M Downs, David F Jarrard, E Jason Abel, Kelvin Wong, Martins Sado, Glen E Leverson, Sutchin R Patel, Tracy M Downs, David F Jarrard

Abstract

Background and objectives: To evaluate the effect of operative time on the risk of symptomatic venous thromboembolic events (VTEs) in patients undergoing robot-assisted radical prostatectomy (RARP).

Methods: We reviewed the records of all patients at our institution who underwent RARP by a single surgeon from January 2007 until April 2011. Clinical and pathologic information and VTE incidence were recorded for each patient and analyzed by use of logistic regression to evaluate for association with VTE risk. All patients had mechanical prophylaxis, and beginning in February 2008, a single dose of unfractionated heparin, 5000 U, was administered before surgery.

Results: A total of 549 consecutive patients were identified, with a median follow-up period of 8 months. During the initial 30 days postoperatively, 10 patients (1.8%) had a VTE (deep venous thrombosis in 7 and pulmonary embolism in 3). The median operative time was 177 minutes (range, 121-360 minutes). An increase in operative time of 30 or 60 minutes was associated with 1.6 and 2.8 times increased VTE risks. A 5-point increase in body mass index and need for blood transfusion were also associated with increased risk of VTEs (odds ratios of 2.0 and 11.8, respectively). Heparin prophylaxis was not associated with a significant VTE risk reduction but also was not associated with a significant increase in estimated blood loss (P = .23) or transfusion rate (P = .37).

Conclusion: A prolonged operative time increases the risk of symptomatic VTEs after RARP. Future studies are needed to evaluate the best VTE prophylactic approach in patients at risk.

References

    1. Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001;(43):i–x, 1–668
    1. Forrest J. Prevention of deep vein thrombosis in patients undergoing urologic surgery. AUA Best Practice Statement 2008 (updated 2011). Accessed: 04/16/14
    1. Kundu SD, Roehl KA, Eggener SE, Antenor JA, Han M, Catalona WJ. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172(6 Pt 1):2227–2231
    1. Secin FP, Jiborn T, Bjartell AS, et al. Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol. 2008;53(1):134–145
    1. Gotto GT, Yunis LH, Guillonneau B, et al. Predictors of symptomatic lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection. Int J Urol. (2011) 18, 291–296
    1. Bolenz C, Gupta A, Hotze T, et al. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol. 2010;57(3):453–458
    1. Agarwal PK, Sammon J, Bhandari A, et al. Safety profile of robot-assisted radical prostatectomy: a standardized report of complications in 3317 patients. Eur Urol. 2011;59(5):684–698
    1. Sammon J, Perry A, Beaule L, Kinkead T, Clark D, Hansen M. Robot-assisted radical prostatectomy: learning rate analysis as an objective measure of the acquisition of surgical skill. BJU Int. 2010;106(6):855–860
    1. Murphy DG, Bjartell A, Ficarra V, et al. Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. Eur Urol. 2010;57(5):735–746
    1. Yong DZ, Tsivian M, Zilberman DE, Ferrandino MN, Mouraviev V, Albala DM. Predictors of prolonged operative time during robot-assisted laparoscopic radical prostatectomy. BJU Int. 2011;107(2):280–282
    1. D'Alonzo RC, Gan TJ, Moul JW, et al. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth. 2009;21(5):322–328
    1. Scales CD, Jr, Jones PJ, Eisenstein EL, Preminger GM, Albala DM. Local cost structures and the economics of robot assisted radical prostatectomy. J Urol. 2005;174(6):2323–2329
    1. Beyer J, Wessela S, Hakenberg OW, et al. Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery. J Thromb Haemost. 2009;7(4):597–604
    1. Morris TA. Natural history of venous thromboembolism. Crit Care Clin. 2011;27(4):869– 884, vi
    1. Eifler JB, Levinson AW, Hyndman ME, Trock BJ, Pavlovich CP. Pelvic lymph node dissection is associated with symptomatic venous thromboembolism risk during laparoscopic radical prostatectomy. J Urol. 2011;185(5):1661–1665
    1. Dobesh PP. Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy. 2009;29(8):943–953
    1. Amin A, Hussein M, Battleman D, Lin J, Stemkowski S, Merli GJ. Appropriate VTE prophylaxis is associated with lower direct medical costs. Hosp Pract (1995). 2010;38(4):130–137
    1. Patel T, Kirby W, Hruby G, Benson MC, McKiernan JM, Badani K. Heparin prophylaxis and the risk of venous thromboembolism after robotic-assisted laparoscopic prostatectomy. BJU Int. 2011;108(5):729–732
    1. Xenos ES, Vargas HD, Davenport DL. Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res. 2012;129(5):568–572
    1. Rodriguez AL, Wojcik BM, Wrobleski SK, Myers DD, Jr, Wakefield TW, Diaz JA. Statins, inflammation and deep vein thrombosis: a systematic review. J Thromb Thrombolysis. 2012;33(4):371–382
    1. Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346(13):975–980

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere