Prevalence and Predictors of Venous Thromboembolism After Robot-Assisted Radical Cystectomy

Objective: To describe incidence and variables associated with venous thromboembolism (VTE) after robot-assisted radical cystectomy (RARC).

Methods: A retrospective review of the prospectively maintained departmental database was performed. Extended thromboprophylaxis (for 4 weeks postoperatively) was implemented November 2017. Patients were divided into VTE (deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) and non-VTE groups. Baseline demographics, disease characteristics and perioperative outcomes were compared. Cochran-Armitage trend test was used to assess trends of VTE. Multivariate logistic regression was used to identify variables associated with VTE. The Kaplan-Meier method was used to depict recurrence free survival (RFS), disease specific survival (DSS), and overall survival (OS).

Results: Twenty nine patients (5%) developed VTE (14 developed DVT and 15 developed PE). Median time to DVT was 28 days and to PE was 23 days after RARC. The rate of VTE remained stable between 2005 and 2020 (P= .99). Patients who developed VTE had significantly higher BMI (31 vs 29, P = .04), had COPD more often (34% vs 14%, P < .01) and had longer median hospital stay (8 vs 7 days, P = .01). Multivariate analysis showed that BMI (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.005-1.10; P = .03), COPD (OR 3.24; 95% CI 1.43-7.30; P < .01),and non-organ confined disease (OR 2.73; 95% CI 1.22-6.11; P = 0.01) were associated with VTE. Kaplan-Meier curves showed that patients who developed VTE exhibited similar RFS (79% vs 64%, P = .28), DSS (90% vs 76%, P = .17), and OS (54% vs 52%, P = .76) at 5 years compared to those who did not develop VTE.

Conclusion: VTE remains a significant complication after RARC. Higher BMI, COPD, and non-organ confined disease were significantly associated with VTE.