highest risk of symptomatic venous thromboembolic events after radical cystectomy occurs in patients with obesity or nonurothelial cancers

Context: Venous thromboembolism (VTE) is a common cause of postoperative morbidity and mortality in cystectomy patients. Aims: The aim of this study is to identify variables associated with risk of developing deep venous thrombosis (DVT) or pulmonary embolism (PE) within 90 days after radical cystectomy (RC). Setting and Design: Retrospective chart review of patients undergoing RC from 2004 to 2011 at the University of Wisconsin. Subjects and Methods: Clinical variables collected for all RC patients. All patients received mechanical prophylaxis, and routine heparin prophylaxis began in 2010. Statistical Analysis Used: Univariate and multivariate analyses were used to evaluate VTE association with known risk factors. Results: A total of 241 patients were identified with median age of 67.1 (interquartile range: 57.8-74.3) years. Body mass index (BMI) was ≥30 in 36.8% of patients. Median blood loss was 950 (600-1500) mL and 157/241 (65.2%) patients received a blood transfusion. Within 90 days postoperatively, overall venous thromboembolic event (VTE) rate was 20/241 (8.3%). Of these, 13 (5 DVT, 8 PE) and 7 (3 DVT, 4 PE) were diagnosed on days 0-30 and days 31-90, respectively. After multivariate analysis, BMI ≥30 (odds ratio [OR] = 4.69, confidence interval [CI] = 1.70-12.92) and nonurothelial bladder cancer (OR = 4.01, CI = 1.33-12.07) were associated with significantly increased rates of VTE. Conclusions: Patients with BMI ≥30 or nonurothelial cancer are at highest risk for postoperative VTE and should be considered for extended heparin prophylaxis.