title: Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography.
abstract: OBJECTIVE
  To detect the incidence of immediate postoperative deep vein thrombosis (DVT) using screening lower extremity ultrasonography (US) in patients undergoing radical cystectomy (RC) and to determine the rate of symptomatic pulmonary embolism (PE) after RC and identify risk factors for venous thromboembolic (VTE) events in a RC population.
  
  
  METHODS
  We performed a retrospective review of prospective data collected on patients who underwent RC between July 2008 and January 2012. These patients underwent screening US at 2/3 days after RC to determine the rate of asymptomatic DVT. A chart review was completed to identify those who had a symptomatic PE. Univariate and multivariable analysis was used to identify risk factors associated with DVT, PE and total VTE events.
  
  
  RESULTS
  In all, 221 patients underwent RC and asymptomatic DVT was identified in 21 (9.5%) on screening US. Nine (4.5%) developed symptomatic PE at a median of 9 days, of which no patients had positive lower extremity US postoperatively. Increased length of hospital stay, increased estimated blood loss, and lower body mass index were linked to risk of PE, and only a previous history of DVT was associated with postoperative DVT.
  
  
  CONCLUSIONS
  Patients who undergo RC are at high-risk for thromboembolic events and multimodal prophylaxis should be administered. Clinicians should be especially vigilant in those who demonstrate factors associated with higher risk for VTE events.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Murray
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: William
authors.initials: W
authors.lastname: Parker
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Stephany
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Kirk
authors.initials: K
authors.lastname: Redger
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Moben
authors.initials: M
authors.lastname: Mirza
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lopez-Corona
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Holzbeierlein
authors.affiliation: University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Lee
keywords: BMI, body mass index; DVT, deep vein thrombosis; Deep vein thrombosis; EBL, estimated blood loss; LMWH, low-molecular weight heparin; LOS, length of hospital stay; PE, pulmonary embolism; Pulmonary embolism; RC, radical cystectomy; Radical cystectomy; US, ultrasonography; Ultrasonography; VTE, venous thromboembolism; Venous thromboembolism