title: Thromboembolic events following surgery for prostate cancer.
abstract: BACKGROUND
  Prostate cancer (PCa) and surgery are both associated with increased risk of thromboembolic diseases (TED).
  
  
  OBJECTIVE
  We assessed risk of TED among men undergoing different types of urologic surgery.
  
  
  METHODS
  Using the Prostate Cancer Database Sweden (PCBaSe) Sweden, we identified all men (n=45 065) undergoing pelvic lymph node dissection (PLND), radical prostatectomy (RP) with or without PLND, orchiectomy due to PCa, or a transurethral resection of the prostate (TURP). We identified a comparison cohort from the population.
  
  
  METHODS
  Main outcomes were deep venous thrombosis (DVT) and pulmonary embolism (PE) as primary diagnoses in the National Patient Register or Cause of Death Register (2002-2010). We calculated hazard ratios (HR) and 95% confidence intervals (CI) using multivariable Cox proportional hazards models.
  
  
  CONCLUSIONS
  All surgical procedures were associated with increased risk of TED; laparoscopic and open RP with a PLND were the most strongly associated with TED (HR for PE: 8.1 [95% CI, 2.9-23.0] and 7.8 [95% CI, 4.9-13], respectively). For surgery including a PLND, the risk increased during the second half of the first postoperative month. The HR for PE after TURP in men with PCa was 3.0 (95% CI, 1.8-5.1). Patients with a history of TED had a strongly increased risk of TED (HR for DVT: 4.5; 95% CI, 2.6-8.0). A limitation is lack of information on TED prophylaxis, but its use was standardized during the study period for RP and PLND. Other limitations are lack of information on extent of PLND and lifestyle factors.
  
  
  CONCLUSIONS
  Surgeries for PCa, including TURP, are associated with hospitalization for TED. Patients with a history of TED and patients undergoing a PLND were at highest risk. The largest risk was observed from days 14 to 28 postoperatively. Thus, our results suggest that prophylactic measures may be beneficial during the first 4 wk in these patients.
authors.affiliation: King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK. mieke.vanhemelrijck@kcl.ac.uk
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.forename: Anna
authors.initials: A
authors.lastname: Bill-Axelson
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.forename: Olof
authors.initials: O
authors.lastname: Akre
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
authors.forename: Jan
authors.initials: J
authors.lastname: Adolfsson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D010388:Pelvis; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000601:surgery*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology*; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000706:statistics & numerical data; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*