Venous thromboembolism after radical prostatectomy: the effect of surgical caseload.

TY - JOUR

T1 - Venous thromboembolism after radical prostatectomy: the effect of surgical caseload.

AU - Schmitges, Jan

AU - Trinh, Quoc-Dien

AU - Sun, Maxine

AU - Abdollah, Firas

AU - Bianchi, Marco

AU - Budäus, Lars

AU - Salomon, Georg

AU - Schlomm, Thorsten

AU - Perrotte, Paul

AU - Shariat, Shahrokh F

AU - Montorsi, Francesco

AU - Menon, Mani

AU - Graefen, Markus

AU - Karakiewicz, Pierre I

PY - 2012

Y1 - 2012

N2 - What's known on the subject? and What does the study add? Several risk factors increase VTE after RP: advanced age, comorbidities such as cardiopulmonary disease, rheumatologic diseases, prior history of VTE, more advanced prostate cancer, and simultaneous pelvic lymph node dissection. To date, the effect of annual surgical caseload (ASC), an established determinant of various RP outcomes, has not been tested. A previous study showed in adjusted analyses that patients operated for colorectal cancer by very high ASC surgeons were 60% less likely to suffer a VTE than those operated by low ASC surgeons. Moreover, some authors hypothesized that laparoscopy may contribute to a higher risk of VTE, due to peritoneal insufflation, reverse Trendelenburg position and prolonged operative time. The VTE rates reported in the current population-based study closely reflect those reported in institutional series. Moreover, we validated the practice-makes-perfect concept, since ASC was linked to VTE. We could not detect statistically significantly differences between minimally invasive radical prostatectomy (MIRP) patients and others. Our results indicate that lower rates of VTE should be expected in patients treated by high ASC surgeons. Our findings suggest that VTE-specific processes of care need to be improved, with the intent of reaching the level recorded in patients treated by high ASC surgeons. Finally, MIRP seems to be no risk factor for VTE.

AB - What's known on the subject? and What does the study add? Several risk factors increase VTE after RP: advanced age, comorbidities such as cardiopulmonary disease, rheumatologic diseases, prior history of VTE, more advanced prostate cancer, and simultaneous pelvic lymph node dissection. To date, the effect of annual surgical caseload (ASC), an established determinant of various RP outcomes, has not been tested. A previous study showed in adjusted analyses that patients operated for colorectal cancer by very high ASC surgeons were 60% less likely to suffer a VTE than those operated by low ASC surgeons. Moreover, some authors hypothesized that laparoscopy may contribute to a higher risk of VTE, due to peritoneal insufflation, reverse Trendelenburg position and prolonged operative time. The VTE rates reported in the current population-based study closely reflect those reported in institutional series. Moreover, we validated the practice-makes-perfect concept, since ASC was linked to VTE. We could not detect statistically significantly differences between minimally invasive radical prostatectomy (MIRP) patients and others. Our results indicate that lower rates of VTE should be expected in patients treated by high ASC surgeons. Our findings suggest that VTE-specific processes of care need to be improved, with the intent of reaching the level recorded in patients treated by high ASC surgeons. Finally, MIRP seems to be no risk factor for VTE.

KW - Humans

KW - Male

KW - Aged

KW - Middle Aged

KW - Prostatectomy/adverse effects/statistics & numerical data

KW - Venous Thromboembolism/epidemiology/etiology

KW - Humans

KW - Male

KW - Aged

KW - Middle Aged

KW - Prostatectomy/adverse effects/statistics & numerical data

KW - Venous Thromboembolism/epidemiology/etiology

M3 - SCORING: Journal article

VL - 110

SP - 828

EP - 833

JO - BJU INT

JF - BJU INT

SN - 1464-4096

IS - 6

M1 - 6

ER -