Saturday, July 13, 2024

Impact of Preoperative Venous Thromboembolism on Bladder Cancer Surgery Outcomes

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The intricate relationship between venous thromboembolism (VTE) and solid malignancies such as bladder cancer (BCa) has long been recognized. With the global rise in BCa cases and a corresponding increase in patients experiencing both BCa and VTE, understanding the impact of a preoperative VTE diagnosis on surgical outcomes and healthcare costs becomes imperative. This study delves into these dynamics, offering insights that could refine perioperative care strategies and cost management for patients undergoing radical cystectomy (RC).

Study Methodology

The study identified adults aged 18 and over diagnosed with BCa and undergoing either open or minimally invasive RC, using data from the Merative™ Marketscan® Research Databases spanning 2007 to 2021. Multivariable logistic regression models, adjusted for patient and perioperative confounders, were employed to assess the association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs. Additionally, a sensitivity analysis was conducted to evaluate the severity of VTE, differentiating between pulmonary embolism (PE) and peripheral deep venous thrombosis (DVT).

Key Findings

Out of 8759 RC procedures, 743 patients (8.48%) had a history of VTE, which included 245 cases of PE, 339 cases of DVT, and 159 cases of superficial VTE. A preoperative VTE history was significantly correlated with worse postoperative outcomes, including a heightened risk for general and apparatus-specific 90-day postoperative complications (odds ratio [OR]: 1.21). Moreover, the incidence of new VTE events post-surgery (OR: 7.02), rehospitalization (OR: 1.25), discharge to non-home/self-care facilities (OR: 1.53), and increased healthcare costs (OR: 1.43) were all notably higher among these patients.

Actionable Insights for Healthcare Providers

  • Patients with a history of VTE undergoing RC should be closely monitored for postoperative complications.
  • Proactive measures to manage and mitigate VTE risks could reduce the likelihood of rehospitalization and subsequent VTE events.
  • Enhanced counseling for BCa patients about the risks associated with surgery, particularly regarding VTE, can lead to better preparedness and informed decision-making.

The findings underscore the importance of recognizing the impact of preoperative VTE in patients undergoing RC. By integrating these insights into clinical practice, healthcare providers can better manage patient outcomes, reduce hospital stays, and control associated costs.

Original Article: Minerva Urol Nephrol. 2024 Jun;76(3):320-330. doi: 10.23736/S2724-6051.24.05699-4.

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