Burden and timing of venothrombolic events in patients younger than 65 years undergoing radical cystectomy for bladder cancer.
OBJECTIVE
Venothrombolic events (VTEs) following radical cystectomy (RC) are a significant contributor to postoperative morbidity. A better understanding of the incidence and timing of VTE would clarify chemoprophylaxis strategies among RC patients. We sought to characterize the burden of VTE after RC by defining their timing and effect utilizing the MarketScan commercial databases.


METHODS
From MarketScan databases, we identified patients younger than 65 years undergoing RC for a primary diagnosis of bladder cancer between 2008 and 2011 with International Classification of Diseases, 9th Edition diagnosis and procedure codes. MarketScan includes inpatient and outpatient health insurance claims of 34 million enrollees annually with data from 150 employers and 13 commercial health plans. We identified the occurrence of VTE, including both pulmonary embolism and deep vein thrombosis, in patients undergoing RC by searching MarketScan for relevant International Classification of Diseases, 9th Edition codes for these diagnoses. Our primary outcome of interest was the timing of VTEs. Multivariate logistical regression models were used to identify patient factors that were associated with VTEs.


RESULTS
A total of 1,581 patients were included in our analysis. Overall, 10% of patients experienced VTEs within 90 days of RC. The incidence of postoperative VTEs during the index admission, after discharge and within 30 days of surgery, and between 31 and 90 days postoperatively was 2.9%, 3.8%, and 3.3%, respectively. Prolonged index hospitalization, discharge to a skilled nursing facility, and orthotopic neobladder urinary diversion were significantly associated with VTE within 30 days of RC.


CONCLUSIONS
Most VTEs occur after discharge from the index RC hospitalization. Consideration should be given to extended chemoprophylaxis in this high-risk group of patients.
Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: acjames@uw.edu.
Andrew C
AC
James
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Sarah K
SK
Holt
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Jonathan L
JL
Wright
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Michael P
MP
Porter
Department of Urology, University of Washington School of Medicine, Seattle, WA.
John L
JL
Gore
D017281:Cost of Illness; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology*; D011655:Pulmonary Embolism / Q000191:economics / Q000209:etiology*; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D020246:Venous Thrombosis / Q000191:economics / Q000209:etiology*
Bladder cancer; Chemoprophylaxis; Complications; Radical cystectomy; Venothrombolic events