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. 2018 Dec 12;3(2):304-313.
doi: 10.1210/js.2018-00278. eCollection 2019 Feb 1.

Is VTE Prophylaxis Necessary on Discharge for Patients Undergoing Adrenalectomy for Cushing Syndrome?

Bruna Babic  1 , Amory De Roulet  1 , Anita Volpe  1 , Naris Nilubol  2
Affiliations

Is VTE Prophylaxis Necessary on Discharge for Patients Undergoing Adrenalectomy for Cushing Syndrome?

Bruna Babic et al. J Endocr Soc. .

Abstract

Background: Patients with Cushing syndrome (CS) have an increased risk for venous thromboembolism (VTE). However, it is unclear whether patients undergoing adrenalectomy for CS are at increased risk for postoperative VTE. The aim of this study was to determine the rate of postoperative VTE in patients undergoing adrenalectomy for CS.

Methods: A retrospective analysis of patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent adrenalectomy from 2005 to 2016 was performed. We compared the clinical characteristics and 30-day postoperative VTE occurrence in patients with and without CS.

Results: A total of 4217 patients were analyzed; 2607 (61.8%) were female and 310 (7.4%) had CS. The overall prevalence of postoperative VTE was 1.0% (n = 45). The rates of VTE were higher in patients with CS (2.6% vs 0.9%; P = 0.007). In the two groups, CS was associated with younger age, increased body mass index, and diabetes mellitus (P < 0.001). CS was also associated with longer length of operation and longer hospital length of stay (P < 0.001). In the subgroup of patients who had diagnosed VTE, CS was associated with longer length of operation (P < 0.001). Rates of laparoscopic vs open surgery were equivalent between patients with and without CS, and VTE events did not differ. The median time to VTE event was 14.5 days (range, 1 to 23 days) in the CS group and 4 days (range, 2 to 25 days) in the group without CS.

Conclusions: The prevalence of postoperative VTE was increased in patients undergoing adrenalectomy for CS. In patients with CS undergoing adrenalectomy, VTE prophylaxis for 28 days should be considered upon discharge.

Keywords: Cushing syndrome; VTE thromboprophylaxis; adrenalectomy; hypercoaguable.

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Figures

Figure 1.
Figure 1.
Study design. Total patients undergoing adrenalectomy. After exclusion of patients (*) not designated as control, 4217 patients were included in the final analysis. #VTE includes both DVT and PE that may have occurred in same individual.
Figure 2.
Figure 2.
Time to VTE in d. The median time of VTE event was 14.5 d (range, 1 to 23 d) in patients with CS compared with 4 d (range, 2 to 25 d) in patients without CS. Box, IQR; line, median; bars, date range.
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