Presentation Authors: Nabeel Shakir*, Daniel Wong, Jeffrey Cadeddu, Claus Roehrborn, Dallas, TX
Introduction: While the overall rate of deep venous thrombosis (DVT) or pulmonary embolism (PE) following robotic assisted radical prostatectomy (RARP) is low, perioperative anticoagulation (AC) is often recommended to prevent morbidity from venous thromboembolic events (VTE). We sought to evaluate the incidence and course of DVT and PE following RARP at our institution, comparing men who received perioperative enoxaparin to those who received no AC, and hypothesized that the VTE rate would be equivalent.
Methods: A hospital system-wide database was queried from January 2006-August 2018 for patients undergoing RARP, who were stratified by the practice of the surgeon: AC (single preoperative subcutaneous injection of enoxaparin) versus no AC. Demographic and perioperative data were compared. The records of men who experienced VTE (DVT or PE) within 6 months of RARP were examined.
Results: A total of 5,772,759 medical records were queried during the study period, of which 3097 men underwent RARP. Most men (2098/3097) received care by a surgeon who did not utilize perioperative AC. As compared to patients receiving AC, the incidence of VTE was comparable (Table 1). Men who had VTE but did not receive preoperative AC (26/2098) were reviewed. Median time to presentation with VTE was 11 days (IQR 5-28) and median length of stay was 1 day (IQR 1-4). Of these patients, 6/26 had history of VTE prior to undergoing RARP and 5/26 remained on lifelong AC following VTE.
Conclusions: In a hospital system-wide review of a high-volume surgical practice, the administration of a single preoperative dose of enoxaparin does not appear to affect the rate of VTE following RARP. Limitations of this analysis include incomplete data on parameters such as operative time, and lack of uniform follow-up; nevertheless, the rate of VTE was overall low