title: Perioperative clinical thromboembolic events after radical or partial nephrectomy.
abstract: OBJECTIVE
  To evaluate the incidence of, and identify the risk factors for, clinical thromboembolic events after radical/partial nephrectomy. Cancer is an established risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE); however, their incidence after nephrectomy for renal tumors has been poorly studied.
  
  
  METHODS
  We reviewed our prospective institutional renal database and identified 2208 patients who underwent renal tumor surgery from January 1989 to July 2005. The clinical parameters evaluated were age, sex, race, body mass index, smoking history, medical comorbidities, American Society of Anesthesia grade, procedure type, estimated blood loss, and length of hospitalization. Hospital records, discharge "International Classification of Diseases, Ninth Revision" codes, and 30-day postoperative morbidity and mortality data were reviewed to identify patients diagnosed with perioperative DVT or PE.
  
  
  RESULTS
  A total of 34 (1.5%, 95% confidence interval 1.1% to 2.1%) thromboembolic events (20 PEs and 14 DVTs) were identified in 33 patients. Patients with a preoperative history of arrhythmia (P = 0.02) or prior DVT (P = 0.053) were more likely to experience PE. The estimated blood loss was directly associated with an increased risk of PE (P = 0.001). Patients with coronary artery disease (P = 0.050) or of advanced age (P = 0.02) were more likely to experience DVT (P = 0.02).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study on the incidence of thromboembolic events after nephrectomy. Thromboembolic events are rare but are more likely to occur in patients with coronary artery disease, cardiac arrhythmia, prior DVT, Stage 3 or 4 tumors, or a large estimated blood loss.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Pettus
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shabsigh
authors.forename: Brent
authors.initials: B
authors.lastname: Yanke
authors.forename: Mark E
authors.initials: ME
authors.lastname: Snyder
authors.forename: Angel
authors.initials: A
authors.lastname: Serio
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.forename: S Machele
authors.initials: SM
authors.lastname: Donat
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology*