Risk Factors Analysis Of Venous Thrombosis In Patients Undergoing Urological Tumor Surgery

Purpose: We examined the incidence of pulmonary thromboembolism(PE)and deep venous thromboembolism(DVT)in patients who underwent urologic tumor surgery.The aim of this study was to investigate the postoperative D-dimer for prediction of venous thromboembolism events(VTE),as well as to identify other risk factors associated with the occurrence of thromboembolisms.Patients and Methods: This was a prospective observational cohort study,which included 1269 patients who underwent major urologic tumor surgery,from August 2015 to February 2017,at our center.Data comprising age,gender,body mass index,Charlson Comorbidity Index,type of surgery,Caprini Score,postoperative D-dimer levels and other laboratory tests were collected for analyses.Lower limb venous ultrasound was performed prior to surgery and the day before hospital discharge to measure DVT.Computerized tomography or ventilation/perfusion lung scan was applied to detect PE.Results: The overall incidence of VTE was 2.4%(31 cases)in 1269 patients,consisting of 23 PE events and 9 DVT events.Patients undergoing radical cystectomy were most likely to suffer VTE(4.3%).The optimal cut-off value for postoperative D-dimer was 0.98 ?g/ml,according to the receiver operating characteristic curve analysis,with a sensitivity of 83.9%,and a specificity of 80.0%.On multivariate analysis,hypertension(OR=2.5,95%CI=1.1-5.7;p=0.026),Charlson Comorbidity Index ? 2(OR=5.6,95%CI=2.2-14.6;p<0.001),and D-dimer lever ?1?g/ml on postoperative day 1(OR=12.5,95%CI=4.6-35.2;p<0.001)were independently associated with VTE after urologic tumor surgery.Conclusions: The overall incidence of urologic-tumor-surgery-associated VTE in an Asian population is similar to those reported in European and North American series.D-dimer ?1?g/ml early after operation is an independent predictor of VTE in patients undergoing urologic tumor surgery.In addition,hypertension and the Charlson Comorbidity Index ? 2 are both important clinical risk factors.The Caprini score recommended by the guideline is inadequate in this study population.The postoperative D-dimer plasma level is a more reliable marker for identifying patients at high-risk of developing venous thromboembolisms.