Clinically overt venous thromboembolism after urologic cancer surgery: results from the @RISTOS Study.
OBJECTIVE
Incidence of venous thromboembolism (VTE) and need for thromboprophylaxis in urologic surgery have received little attention since only one randomised study has addressed this issue in the last 20 yr. The present prospective observational study evaluated incidence and risk factors for clinically overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and compared findings in urologic patients with those in patients undergoing general or gynaecologic surgery.


METHODS
Patients having cancer surgery (general surgery, gynaecology, urology) were assessed for clinically overt VTE occurring up to 30+/-5 d after intervention or more if the hospital stay was longer. All suspected VTE events were evaluated by an external independent Adjudication Committee.


RESULTS
A total of 2373 patients, 1238 (52%) undergoing general surgery, 685 (29%) urologic, and 450 (19%) gynaecologic surgery were evaluated. In urologic patients, most procedures (61%) were endoscopic, with bladder and prostate cancer being the most frequent tumours. In-hospital thromboprophylaxis was given to 71.7% of patients, whereas 32.5% received prophylaxis after discharge. The incidence of VTE in urologic patients was lower (0.87%) than that in general surgery and gynaecologic patients (2.8% and 2.0%, respectively). VTE consisted of three cases of nonfatal and three cases of fatal pulmonary embolism (PE). In four of the six cases, VTE occurred during prophylaxis.


CONCLUSIONS
VTE still represents a severe complication and remains the most common cause of death after urologic cancer surgery. Efforts should be made to optimise prophylactic measures to further reduce such risk.
Scarpa
Roberto M
RM
Division of Urology, University of Turin, Orbassano, Italy.
Carrieri
Giuseppe
G
Gussoni
Gualberto
G
Tubaro
Andrea
A
Conti
Giario
G
Pagliarulo
Vincenzo
V
Mirone
Vincenzo
V
De Lisa
Antonello
A
Fiaccavento
Gaspare
G
Cormio
Luigi
L
Bonizzoni
Erminio
E
Agnelli
Giancarlo
G
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D014565:Urogenital Neoplasms / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control