title: Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population-based study.
abstract: OBJECTIVE
  To describe the risk factors and timing of perioperative venous thromboembolism (VTE) and its association with survival for patients undergoing radical cystectomy (RC) in routine clinical practice.
  
  
  METHODS
  The population-based Ontario Cancer Registry was linked to electronic records of treatment to identify all patients who underwent RC between 1994 and 2008; VTE events were identified from hospital diagnostic codes. Multivariate logistic regression analysis was used to determine the factors associated with perioperative VTE. A Cox proportional hazards regression model explored the associations between VTE and survival.
  
  
  RESULTS
  Of the 3 879 patients included in the study, 3.6% (141 patients) were diagnosed with VTE at ≤1 month of their surgical admission date. This increased to 4.7% (181) at ≤2 months and 5.4% (211) at ≤3 months. In all, 55% of VTE events presented after hospital discharge. In multivariate analysis, factors associated with VTE included higher surgeon volume (P = 0.004) and increased length of hospital stay (LOS; P < 0.001). Lymph node yield and adjuvant chemotherapy were not associated with VTE. VTE was associated with an inferior cancer-specific survival [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.13-1.62] and overall survival (HR 1.27, 95% CI 1.08-1.49).
  
  
  CONCLUSIONS
  Over half of VTE events in RC patients occur after hospital discharge, with a substantial incidence up to 3 months after surgery. Limited actionable risk factors for VTE were identified other than LOS. In this population-based cohort, VTE was associated with inferior long-term survival.
authors.affiliation: Department of Urology, Queen's University, Kingston, ON, Canada.
authors.forename: R Christopher
authors.initials: RC
authors.lastname: Doiron
authors.affiliation: Department of Oncology, Queen's University, Kingston, ON, Canada.|Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.|Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Booth
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.
authors.forename: Xuejiao
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Urology, Queen's University, Kingston, ON, Canada. siemensr@kgh.kari.net.|Department of Oncology, Queen's University, Kingston, ON, Canada. siemensr@kgh.kari.net.|Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada. siemensr@kgh.kari.net.
authors.forename: D Robert
authors.initials: DR
authors.lastname: Siemens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology*; D055815:Young Adult
keywords: bladder cancer; radical cystectomy; survival; venous thromboembolism