JU INSIGHT Risk of Postoperative Thromboembolism in Men Undergoing Urological Prosthetic Surgery: An Assessment of 21,413 Men

By: Kevin J. Hebert, MD; Rano Matta, MD, MSc; Joshua J. Horns, PhD; Niraj Paudel, MS; Rupam Das, MBA; Tobias S. Kohler, MD, MPH; Alexander W. Pastuszak, MD, PhD; Benjamin J. McCormick, MD; James M. Hotaling, MD, MS; Jeremy B. Myers, MD | Posted on: 01 Oct 2022

Hebert KJ, Matta R, Horns JJ, et al. Risk of postoperative thromboembolism in men undergoing urological prosthetic surgery: an assessment of 21,413 men. J Urol; 2022;208(4)878-885.

Study Need and Importance

There are a lack of guideline-based recommendations on perioperative venous thromboembolism (VTE) prophylaxis in the artificial urinary sphincter (AUS) and inflatable penile prosthesis (IPP) surgery populations. Previous attempts to characterize VTE risk in this population have been limited by underpowered studies. Given the elective nature of urological prosthetic surgery, accurate estimates of postoperative morbidity are important not only to appropriately counsel patients in the preoperative setting, but also to mitigate risk.

Table. Multivariable model for incidence of DVT or PE in the AUS and IPP cohorts

Cofactor	AUS Surgery			IPP Surgery
	HR	95% CI	p Value	HR	95% CI	p Value
Region:			0.8			0.8
Midwest	0.72	0.34–1.52	0.4	0.83	0.53–1.32	0.4
South	0.87	0.44–1.70	0.7	0.78	0.51–1.19	0.2
West	0.63	0.27–1.46	0.3	0.82	0.46–1.46	0.5
Other	0.89	0.12–6.90	0.9	1.12	0.34–3.68	0.9
Bladder Ca	1.21	0.58–2.54	0.6	0.79	0.32–1.96	0.6
Prostate Ca	1.41	0.73–2.73	0.3	1.16	0.81–1.65	0.4
Prostatectomy	0.32	0.15–0.68	0.003	0.65	0.38–1.13	0.13
Diabetes mellitus	1.27	0.76–2.10	0.4	0.74	0.53–1.02	0.067
Peripheral vascular disease	0.49	0.21–1.20	0.11	1.08	0.71–1.64	0.7
Cardiovascular disease	0.82	0.49–1.37	0.5	1.22	0.88–1.71	0.2
Hypertension	1.17	0.64–2.12	0.6	1.16	0.79–1.72	0.4
Varicose veins	2.76	1.12–6.79	0.02	0.92	0.50–1.71	0.8
Smoking	0.54	0.19–1.55	0.3	0.91	0.55–1.51	0.7
Previous DVT	13.7	7.40–25.19	<0.001	12.6	7.99–19.93	<0.001
Previous PE	7.65	4.01–14.60	<0.001	8.90	5.60–14.13	<0.001
Age	0.99	0.97–1.02	0.6	0.99	0.99–1.01	0.5
Effect of region relative to Northeast; effect of comorbidities relative to patients without; effect of age effect of 1-year increase at time of surgery. Statistically significant results in bold.

What We Found

Among 4,870 men undergoing AUS surgery and 16,543 men undergoing IPP surgery, the prevalence of preoperative VTE was 3.7% and 2.6%, respectively. Within 90 days of surgery, deep vein thrombosis (DVT) and/or pulmonary embolism (PE) occurred in 1.54% (AUS) and 1.04% (IPP) of cases. Preoperative variables independently associated with increased risk of postoperative VTE included prior history of PE (HR 7.7 AUS; HR 8.9 IPP), DVT (13.7 AUS; 12.6 IPP), and varicose veins (HR 2.8, AUS; see Table).

Limitations

While utilization of an insurance claims database allows followup across hospital systems, its main limitation relates to the lack of access to individual patient medical records. Likewise, this study population is limited to men with health insurance and may not adequately represent risk in men without insurance.

Interpretation for Patient Care

Our findings reveal a higher than expected risk of postoperative DVT and PE following AUS and IPP surgery. Preoperative risk stratification should be considered as men with a prior history of DVT, PE, and varicose veins appear to be at highest risk for postoperative VTE and may benefit from perioperative VTE prophylaxis.