Presentation Authors: Timothy Lyon*, Nilay Shah, Paras Shah, Lindsey Sangaralingham, Dennis Asante, R. Houston Thompson, Matthew Tollefson, R. Jeffrey Karnes, Igor Frank, Stephen Boorjian, Rochester, MN
Introduction: Venous thromboembolism (VTE) is an important cause of morbidity following radical cystectomy (RC) for bladder cancer. Accumulating evidence suggests that the risk of postoperative VTE may be lowered by discharging patients on extended-duration pharmacologic prophylaxis (EDPP). However, the degree to which this practice occurs in the United States has not been well studied. Herein, we evaluated temporal trends in outpatient VTE prophylaxis prescriptions following RC, and assessed patient as well as practice-level characteristics associated with receiving EDPP.
Methods: We used OptumLabs Data Warehouse, a national administrative claims database, to identify patients undergoing RC for MIBC from 2012-2017. Patients with initial hospital stay > 30 days or those on therapeutic dose anticoagulants were excluded. Rates of filled outpatient prescriptions for prophylactic dose low molecular weight heparin or fondaparinux following index hospitalization for RC were assessed, and rate over time was evaluated using the Cochran-Armitage test for trend. Multivariable logistic regression was used to examine associations between clinical and practice-level features with EDPP.
Results: A total of 2,055 patients were identified. The rate of EDPP prescriptions for patients discharged after RC increased significantly over the study period, from 9% of cases in 2012 to 26% of cases in 2017 (p < 0.001). On multivariable logistic regression, age < 65 (OR 1.69, 95% CI 1.33-2.17, p < 0.001), more recent procedure year (OR 3.70, 95% CI 2.37-5.75, p < 0.001), mild liver disease (OR 1.66, 95% CI 1.21-2.27, p=0.002), metastatic cancer (OR 1.31, 95% CI 1.04-1.65, p=0.02) and receipt of neoadjuvant chemotherapy (OR 1.52, 95% CI 1.18-1.96, p=0.001) were significantly associated with odds of receiving a prescription.
Conclusions: EDPP following RC has increased over time, but is still provided for only a minority of cases. Further efforts are warranted to study the potential benefits and risks of EDPP as utilization increases.