To assess the impact of a positive history of venous thromboembolism (VTE) on perioperative outcomes, including length of in-hospital stay, readmission rates, 90-day postoperative complications, and healthcare costs in bladder cancer (BCa) patients undergoing transurethral resection of bladder tumour (TURBT) in the United States.
Patients aged ≥18 years with a BCa diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de-identified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between diagnosis of VTE before TURBT and 90-day complication rates, new postoperative VTE events, re-hospitalization, and total hospital expenditures (2021 US dollars). Sensitivity analyses on VTE severity (pulmonary embolism [PE], deep venous thrombosis [DVT] or superficial thrombophlebitis/phlebitis [SVT]), as well as TURBT extent (minor vs. major) were additionally examined.
In total, 139 800 patients were identified, with 5.3% having preoperative VTE, including DVT (n = 3112, 42.20%), PE (n = 2046, 27.74%) and SVT (n = 2217, 30.06%). A history of preoperative VTE predicted higher rates of any complication (adjusted odds ratio [aOR] 1.28, 95% CI 1.14-1.43) and also higher rates of infectious and haemorrhagic complications. Additionally, preoperative VTE increased the risk of novel VTE events following TURBT (aOR 17.30, 95% CI 16.05-18.65), hospital length of stay (aOR 2.23, 95% CI 1.90-2.62), readmissions (aOR 1.47, 95% CI 1.39-1.56), and hospital associated costs (aOR 1.17, 95% CI 1.12-1.23). DVT and non-minor TURBT procedures did not increase the risk of any, infectious, or haemorrhagic complications, but other associations were maintained regardless of the severity of VTE (PE, DVT, SVT) or TURBT extent (minor/major).
A history of VTE before undergoing transurethral procedures for BCa is associated with significantly worse perioperative outcomes and higher healthcare costs. These findings may help us to counsel on the risks of the intervention and hopefully improve our ability to mitigate such risks.
BJUI compass. 2025 Jan 14*** epublish ***
Anas S Tresh, Francesco Del Giudice, Shufeng Li, Satvir Basran, Ettore De Berardinis, Dalila Carino, Valerio Santarelli, Bernardo Rocco, Maria Chiara Shighinolfi, Roman Mayr, Matteo Ferro, Riccardo Autorino, Gabriele Bignante, Felice Crocetto, Biagio Barone, Renate Pichler, José Daniel Subiela, Jorge Caño Velasco, Marco Moschini, Andrea Mari, Andrea Gallioli, Francesco Soria, Simone Albisinni, Wojciech Krajewski, Jan Łaszkiewicz, Łukasz Nowak, Tomasz Szydełko, Benjamin Challacombe, Rajesh Nair, Benjamin I Chung
Department of Urology Stanford University School of Medicine Stanford CA USA., Department of Maternal Infant and Urologic Sciences "Sapienza" University of Rome, Policlinico Umberto I Hospital Rome Italy., Urologic Unit, ASST Santi Paolo e Carlo La Statale University Milan Italy., Department of Urology, St. Josef Medical Center University of Regensburg Regensburg Germany., Department of Urology European Institute of Oncology (IEO) IRCCS Milan Italy., Department of Urology Rush University Medical Center Chicago IL USA., Department of Neurosciences, Reproductive Sciences and Odontostomatology University of Naples Federico II Naples Italy., Department of Urology, Comprehensive Cancer Center Innsbruck Medical University of Innsbruck Innsbruck Austria., Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS Universidad de Alcala Madrid Spain., Department of Urology Gregorio Marañón University Hospital Madrid Spain., Division of Experimental Oncology, Unit of Urology IRCCS Ospedale San Raffaele Milan Italy., Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital University of Florence Florence Italy., Department of Urology, Fundació Puigvert Universitat Autonoma de Barcelona Barcelona Spain., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital University of Studies of Torino Turin Italy., Unit of Urology, Department of Surgical Sciences Tor Vergata University Rome Italy., University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology Wroclaw Medical University Wroclaw Poland., Guy's and St. Thomas' NHS Foundation Trust Guys and St Thomas' Hospital London UK.