Nationwide practice patterns for the use of venous thromboembolism prophylaxis among men undergoing radical prostatectomy

Abstract

Purpose: To examine the practice patterns and predictors of VTE prophylaxis following radical prostatectomy (RP).

Methods: This was a population-based observational study of 94,709 men with a diagnosis of prostate cancer (ICD-9 code 185) who underwent RP were identified from a hospital-based database from 2000 to 2010, including 68,244 (72.1 %) open RP (ORP) and 26,465 (27.9 %) robotic-assisted laparoscopic RP (RALP). VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination.

Results: Following RP, 35,591 (52.2 %) received mechanical, 4,945 (7.2 %) pharmacologic, 7,720 (10.6 %) combination, and 20,438 (30.0 %) no VTE prophylaxis. A total of 245 VTE events (145 DVT, 114 PE) were identified, representing 0.25 % of all procedures. Men with >2 comorbidities (OR = 2.44; 95 % CI 1.78-3.35) and those who were black (OR = 1.44; 95 % CI 1.06-1.97) were more likely to have a VTE. Men who had RALP (OR = 0.61; 95 % CI 0.45-0.99), surgery at high-volume hospitals (OR = 0.45; 95 % CI 0.28-0.73), or received prophylaxis (OR = 0.67; 95 % CI 0.50-0.88) were less likely to develop a VTE.

Conclusion: Despite the observation that VTE prophylaxis reduces the risk of VTE by 40 %, VTE prophylaxis was not used in almost one-third of men who underwent radical prostatectomy.