Burden and timing of venothrombolic events in patients younger than 65 years undergoing radical cystectomy for bladder cancer

Introduction and objectives: Venothrombolic events (VTEs) following radical cystectomy (RC) are a significant contributor to postoperative morbidity. A better understanding of the incidence and timing of VTE would clarify chemoprophylaxis strategies among RC patients. We sought to characterize the burden of VTE after RC by defining their timing and effect utilizing the MarketScan commercial databases. Methods: From MarketScan databases, we identified patients younger than 65 years undergoing RC for a primary diagnosis of bladder cancer between 2008 and 2011 with International Classification of Diseases, 9th Edition diagnosis and procedure codes. MarketScan includes inpatient and outpatient health insurance claims of 34 million enrollees annually with data from 150 employers and 13 commercial health plans. We identified the occurrence of VTE, including both pulmonary embolism and deep vein thrombosis, in patients undergoing RC by searching MarketScan for relevant International Classification of Diseases, 9th Edition codes for these diagnoses. Our primary outcome of interest was the timing of VTEs. Multivariate logistical regression models were used to identify patient factors that were associated with VTEs. Results: A total of 1,581 patients were included in our analysis. Overall, 10% of patients experienced VTEs within 90 days of RC. The incidence of postoperative VTEs during the index admission, after discharge and within 30 days of surgery, and between 31 and 90 days postoperatively was 2.9%, 3.8%, and 3.3%, respectively. Prolonged index hospitalization, discharge to a skilled nursing facility, and orthotopic neobladder urinary diversion were significantly associated with VTE within 30 days of RC. Conclusion: Most VTEs occur after discharge from the index RC hospitalization. Consideration should be given to extended chemoprophylaxis in this high-risk group of patients.