The relationship between malignancy and VTE has been thoroughly well established and VTE is the leading cause of non-cancer deaths in patients undergoing cancer surgery as well as a significant source of morbidity, mortality, and hospital costs. Over the last decades, the incidence of VTE in cancer patients has continued to rise, as well as the number of Bladder Cancer (BCa) cases worldwide. Patients undergoing radical cystectomy (RC) for BCa also have an increased risk of VTE compared to other major urologic procedures. Most of the literature has focused on the incidence of VTE in BCa patients postoperatively. To our knowledge, there have been no other studies that have looked at the risk associated with patients with known VTE and BCa undergoing RC.
Our new study published in Minerva Urology and Nephrology 2024 took a new approach to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and healthcare costs in BCa cases undergoing radical cystectomy (RC).1
We identified in the Merative™ Marketscan® Research Databases a cohort of patients with BCa diagnosis and undergoing open or minimally invasive (MIS) RC between 2007 and 2021. We utilized multivariable logistic regression modeling that was adjusted for patient and perioperative confounders.
We aimed to investigate retrospectively the impact of previous VTE diagnoses on any, and 90-day postoperative complications, novel VTE events, median in-hospital length of stay, discharge status, readmission rates, and total health cost related to the whole RC index recovery. We also wanted to assess the relative influence of the severity of the VTE event stratified as PE versus lower/upper DVT extremity versus peripheral phlebitis/thrombophlebitis on the pre-specified outcomes.
Interestingly, among patients undergoing RC, we identified a consistent group with a previous positive history of any VTE, such as PE, DVT, and superficial VTE, comprising 8.48% of the patient cohort.
We discovered that a history of VTE prior to RC was strongly associated with worse postoperative outcomes of almost all types including a higher risk for any and 90-day postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Also, a history of VTE was also significantly associated with a subsequent increased incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), being discharged to a site other than home/self-care (OR: 1.53, 95% CI:1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68).
Based on our findings, a preoperative VTE diagnosis has a strong influence on perioperative and/or postoperative outcomes. As BCa patients undergoing RC at baseline tend to have a number of complications typically requiring further interventions, those, especially those with a history of preoperative VTE, must be kept in mind for an even higher rate of potential issues.
Considering the association between RC and VTE is well known with rates ranging from 2-14%, to optimize future BCa patient care our study is unique and significant for several reasons. First, it identifies how preoperative VTE in patients undergoing RC significantly increases morbidity and the incidence of post-procedure VTE events. Also, as a result, there is an increase in hospital length of stay, rehospitalizations, and downstream hospital costs. Our study represents an important tool for further evaluation of risks of surgical intervention so as to be possible to improve our ability to mitigate such risks and reduce healthcare costs.
Written by: Roberta Corvino, Francesco Del Giudice, Benjamin I. Chung
- Department of Maternal Infant and Urologic Sciences, “Sapienza” University of Rome, Rome, ITA
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
References:
Read the Abstract